Provider Demographics
NPI:1790862845
Name:WARDELL, MARY ANNETTE (MD)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ANNETTE
Last Name:WARDELL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:901 S NATIONAL AVE
Mailing Address - Street 2:TAYLOR HEALTH & WELLNESS CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65897
Mailing Address - Country:US
Mailing Address - Phone:417-836-4000
Mailing Address - Fax:417-836-4133
Practice Address - Street 1:901 S NATIONAL AVE
Practice Address - Street 2:TAYLOR HEALTH & WELLNESS CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897
Practice Address - Country:US
Practice Address - Phone:417-836-4000
Practice Address - Fax:417-836-4133
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO100894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F98149Medicare UPIN