Healthcare Provider Details

I. General information

NPI: 1598736688
Provider Name (Legal Business Name): MARY ALICE MC FAD MARTINIE R.N. F.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12670 CREEKSIDE LANE STE 202
FT MYERS FL
33919-8759
US

IV. Provider business mailing address

12670 CREEKSIDE LANE STE 202
FT MYERS FL
33919-8759
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-2663
  • Fax: 239-482-3106
Mailing address:
  • Phone: 239-482-2663
  • Fax: 239-482-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberRN1536802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: