Provider Demographics
NPI:1134198286
Name:RAYMOND, MARY CATHERINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:FLINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1913 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242
Mailing Address - Country:US
Mailing Address - Phone:530-349-1328
Mailing Address - Fax:530-349-1328
Practice Address - Street 1:530 W ACACIA ST STE 1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2400
Practice Address - Country:US
Practice Address - Phone:209-944-5410
Practice Address - Fax:209-944-5477
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN428834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily