Provider Demographics
NPI:1730472127
Name:CLARE, MARY VIRGINIA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:VIRGINIA
Last Name:CLARE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2786 STONY BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:GA
Mailing Address - Zip Code:30426-3733
Mailing Address - Country:US
Mailing Address - Phone:912-829-3510
Mailing Address - Fax:912-829-3510
Practice Address - Street 1:2786 STONY BLUFF RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:GA
Practice Address - Zip Code:30426-3733
Practice Address - Country:US
Practice Address - Phone:912-829-3510
Practice Address - Fax:912-829-3510
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118261367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered