Provider Demographics
NPI:1932408481
Name:COUSINEAU, MARY PUTNAM (BC-PNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PUTNAM
Last Name:COUSINEAU
Suffix:
Gender:F
Credentials:BC-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LA MIRADA CT
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3857
Mailing Address - Country:US
Mailing Address - Phone:831-422-6750
Mailing Address - Fax:
Practice Address - Street 1:10561 MERRITT ST
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95012-3310
Practice Address - Country:US
Practice Address - Phone:831-633-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN280086163W00000X
CA202363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse