Provider Demographics
NPI:1336378983
Name:HARGROVE, MARY ANNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNETTE
Last Name:HARGROVE
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 1:83 GOVERNOR BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2777
Mailing Address - Country:US
Mailing Address - Phone:757-345-5292
Mailing Address - Fax:757-345-5292
Practice Address - Street 1:83 GOVERNOR BERKELEY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2777
Practice Address - Country:US
Practice Address - Phone:757-345-5292
Practice Address - Fax:757-345-5292
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001216798163W00000X
FLRN2214262163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse