Provider Demographics
NPI:1760862270
Name:BEAR-TASHQUINTH, MARY (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BEAR-TASHQUINTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:BEAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 8157
Mailing Address - Street 2:HCO1
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634
Mailing Address - Country:US
Mailing Address - Phone:520-383-7007
Mailing Address - Fax:520-362-7080
Practice Address - Street 1:HIGHWAY 86/MILEMARKER 74
Practice Address - Street 2:HCO1
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-383-7007
Practice Address - Fax:520-362-7080
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse