Provider Demographics
NPI:1255645990
Name:IRELAND, MARY JANE (APRN-FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1901 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504
Mailing Address - Country:US
Mailing Address - Phone:254-743-0441
Mailing Address - Fax:
Practice Address - Street 1:1901 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-743-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652337363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner