Healthcare Provider Details

I. General information

NPI: 1033021712
Provider Name (Legal Business Name): MARY MCCARTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 JAMES STREET
LAWRENCEVILLE IL
62439
US

IV. Provider business mailing address

2101 JAMES ST
LAWRENCEVILLE IL
62439
US

V. Phone/Fax

Practice location:
  • Phone: 618-943-3302
  • Fax: 618-943-7589
Mailing address:
  • Phone: 618-943-3302
  • Fax: 618-943-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.036608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: