Provider Demographics
NPI:1134259435
Name:BAHAN, MARY (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:BAHAN
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 1:700 E 9TH ST
Mailing Address - Street 2:APT 80
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3978
Mailing Address - Country:US
Mailing Address - Phone:501-537-4213
Mailing Address - Fax:
Practice Address - Street 1:2411 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4211
Practice Address - Country:US
Practice Address - Phone:501-982-5402
Practice Address - Fax:501-982-5404
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR42049163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult