Provider Demographics
NPI:1851750749
Name:MAHON, BARBARA A (AGPCNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:MAHON
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TURNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5574
Mailing Address - Country:US
Mailing Address - Phone:845-837-1753
Mailing Address - Fax:
Practice Address - Street 1:19 TURNBERRY CT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-5574
Practice Address - Country:US
Practice Address - Phone:845-837-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307634363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health