Provider Demographics
NPI:1922292846
Name:MAIER, MARY CECILIA
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CECILIA
Last Name:MAIER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CECILIA
Other - Last Name:BAJARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN CNP
Mailing Address - Street 1:17372 COUNTY ROAD 37 NW
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MN
Mailing Address - Zip Code:55382-4003
Mailing Address - Country:US
Mailing Address - Phone:320-493-7749
Mailing Address - Fax:
Practice Address - Street 1:17372 COUNTY ROAD 37 NW
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MN
Practice Address - Zip Code:55382-4003
Practice Address - Country:US
Practice Address - Phone:320-493-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2007005555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily