Provider Demographics
NPI:1790434413
Name:DRENON, MARY J (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:DRENON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-4042
Mailing Address - Country:US
Mailing Address - Phone:660-281-0165
Mailing Address - Fax:
Practice Address - Street 1:2303 S HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3734
Practice Address - Country:US
Practice Address - Phone:660-886-3364
Practice Address - Fax:800-698-3627
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022009494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily