Provider Demographics
NPI:1740491901
Name:ALBAUGH, MARYANN (NP)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:ALBAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-434-6433
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2020-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28080508A163W00000X
TX766988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes163W00000XNursing Service ProvidersRegistered Nurse