Provider Demographics
NPI:1710056817
Name:PLACEY, MARY ANN (NP)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:PLACEY
Suffix:
Gender:F
Credentials:NP
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 4425
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-4425
Mailing Address - Country:US
Mailing Address - Phone:336-886-9003
Mailing Address - Fax:
Practice Address - Street 1:2638 WILLARD DAIRY RD STE 102
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8236
Practice Address - Country:US
Practice Address - Phone:336-858-5035
Practice Address - Fax:336-887-5696
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200611163WG0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC500009345Medicare PIN
NC2592462BMedicare PIN
S11741Medicare UPIN