Provider Demographics
NPI:1851669436
Name:SPRINGER, MARY (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SAVAGE ST APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2472
Mailing Address - Country:US
Mailing Address - Phone:415-672-0116
Mailing Address - Fax:
Practice Address - Street 1:18 SAVAGE ST APT B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2472
Practice Address - Country:US
Practice Address - Phone:415-672-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA705755163WE0003X, 163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WF0300XNursing Service ProvidersRegistered NurseFlight
No163WE0003XNursing Service ProvidersRegistered NurseEmergency