Provider Demographics
NPI:1205279304
Name:CANALE, MARY F (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:F
Last Name:CANALE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-0032
Mailing Address - Country:US
Mailing Address - Phone:413-727-3534
Mailing Address - Fax:413-341-1789
Practice Address - Street 1:82 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3942
Practice Address - Country:US
Practice Address - Phone:413-788-0100
Practice Address - Fax:413-341-1789
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN279347363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health