Provider Demographics
NPI:1922596519
Name:CARRAWAY, MARY ANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CARRAWAY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-0419
Mailing Address - Country:US
Mailing Address - Phone:804-317-4599
Mailing Address - Fax:804-561-1454
Practice Address - Street 1:8840 OTTERBURN RD
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4853
Practice Address - Country:US
Practice Address - Phone:804-317-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001126607163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse