Provider Demographics
NPI:1013757657
Name:HYSLOP, MARY PATRICIA (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:PATRICIA
Last Name:HYSLOP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7573
Mailing Address - Country:US
Mailing Address - Phone:925-505-4700
Mailing Address - Fax:
Practice Address - Street 1:2441 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7573
Practice Address - Country:US
Practice Address - Phone:925-505-4700
Practice Address - Fax:925-371-4410
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine