MEDICARE: MARY M. MARTIN-VAVRA MS, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F338051	NY

General Provider Information

NPI Number	:	1811338551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M. MARTIN-VAVRA MS, FNP

Provider Business Mailing Address
First Line	:	16415 NORTHCROSS DR STE B
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5001
Country	:	US
Telephone Number	:	704-775-6029
Fax Number	:

Provider Business Practice Location Address
First Line	:	16415 NORTHCROSS DR STE B
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5001
Country	:	US
Telephone Number	:	704-775-6029
Fax Number	:	607-547-3844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	01/19/2026

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