Provider Demographics
NPI:1588653323
Name:MCCARTHY, ANN MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1015
Mailing Address - Street 2:
Mailing Address - City:WATERFLOW
Mailing Address - State:NM
Mailing Address - Zip Code:87421-1015
Mailing Address - Country:US
Mailing Address - Phone:505-320-5209
Mailing Address - Fax:
Practice Address - Street 1:1 COUNTY ROAD 6788
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:NM
Practice Address - Zip Code:87416
Practice Address - Country:US
Practice Address - Phone:505-320-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR5088Medicaid
AZ693384Medicaid
CO71883070Medicaid
NMR5088Medicaid
AZ693384Medicaid
P36530Medicare UPIN