Provider Demographics
NPI:1912366790
Name:CRYER, MARY (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CRYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 MESA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-6709
Mailing Address - Country:US
Mailing Address - Phone:805-614-5640
Mailing Address - Fax:805-614-5641
Practice Address - Street 1:1560 MESA RD STE 100
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-6709
Practice Address - Country:US
Practice Address - Phone:805-614-5640
Practice Address - Fax:805-614-5641
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily