Provider Demographics
NPI:1588671069
Name:JOSWIG, MARY E (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:JOSWIG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2328
Mailing Address - Country:US
Mailing Address - Phone:760-806-5540
Mailing Address - Fax:760-945-4917
Practice Address - Street 1:130 CEDAR RD # 200
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5102
Practice Address - Country:US
Practice Address - Phone:760-806-5540
Practice Address - Fax:760-945-4917
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN267491163W00000X
CA5915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN267491Medicaid
CAP09311Medicare UPIN
CAWNP5915AMedicare ID - Type Unspecified