Provider Demographics
NPI:1659487106
Name:SETNESS, MARY LG (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LG
Last Name:SETNESS
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Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:8417 BALBOA AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2432
Mailing Address - Country:US
Mailing Address - Phone:209-473-0982
Mailing Address - Fax:209-473-0964
Practice Address - Street 1:1800 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6019
Practice Address - Country:US
Practice Address - Phone:209-467-6556
Practice Address - Fax:209-467-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA2445976386363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology