Provider Demographics
NPI:1881648194
Name:PIPER, MARY K (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:PIPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W WHITTAKER ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1917
Mailing Address - Country:US
Mailing Address - Phone:618-548-3740
Mailing Address - Fax:
Practice Address - Street 1:1250 W WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1917
Practice Address - Country:US
Practice Address - Phone:618-548-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE9335OtherRR GRP
ILK22949Medicare PIN
CE9335OtherRR GRP
K39204Medicare PIN