Provider Demographics
NPI:1689658536
Name:MAGUIRE, MARY Z (MSN CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:Z
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 CROOKED OAK DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4207
Mailing Address - Country:US
Mailing Address - Phone:717-569-5331
Mailing Address - Fax:717-569-4210
Practice Address - Street 1:1671 CROOKED OAK DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4207
Practice Address - Country:US
Practice Address - Phone:717-569-5331
Practice Address - Fax:717-569-4210
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006791C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23662Medicare UPIN
PA045174FX1Medicare ID - Type Unspecified