Provider Demographics
NPI:1750509485
Name:KAVANAGH, MARY (NR)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:NR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 OSBORNE CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3202
Mailing Address - Country:US
Mailing Address - Phone:201-529-9007
Mailing Address - Fax:
Practice Address - Street 1:35D PIERMONT ROAD
Practice Address - Street 2:
Practice Address - City:ROCKLEIGH
Practice Address - State:NJ
Practice Address - Zip Code:07647
Practice Address - Country:US
Practice Address - Phone:201-784-6490
Practice Address - Fax:201-784-6495
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR07468500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse