Provider Demographics
NPI:1811338551
Name:MARTIN-VAVRA, MARY M (MS, FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:MARTIN-VAVRA
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16415 NORTHCROSS DR STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5001
Mailing Address - Country:US
Mailing Address - Phone:704-775-6029
Mailing Address - Fax:
Practice Address - Street 1:16415 NORTHCROSS DR STE B
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5001
Practice Address - Country:US
Practice Address - Phone:704-775-6029
Practice Address - Fax:607-547-3844
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily