Provider Demographics
NPI:1821191347
Name:BEARE, MARY VIRGINIA (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:VIRGINIA
Last Name:BEARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39700 BOB HOPE DR
Mailing Address - Street 2:SUITE 216
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3267
Mailing Address - Country:US
Mailing Address - Phone:760-837-8905
Mailing Address - Fax:760-837-8956
Practice Address - Street 1:39700 BOB HOPE DR
Practice Address - Street 2:SUITE 216
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3267
Practice Address - Country:US
Practice Address - Phone:760-837-8905
Practice Address - Fax:760-837-8956
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP16499363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health