Provider Demographics
NPI:1851060057
Name:MANN, MARY (CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 AUBURN AVENUE
Mailing Address - Street 2:ATTN: PAYOR ENROLLMENT 4-7
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-351-9900
Mailing Address - Fax:
Practice Address - Street 1:8780 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-6936
Practice Address - Country:US
Practice Address - Phone:859-384-8320
Practice Address - Fax:859-384-8338
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.0029684363LF0000X
KY3016190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily