Healthcare Provider Details

I. General information

NPI: 1932256948
Provider Name (Legal Business Name): MARY S NETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E SUPERIOR ST SUITE 109
DULUTH MN
55802-2238
US

IV. Provider business mailing address

925 E SUPERIOR ST STE 109
DULUTH MN
55802-2238
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-3700
  • Fax:
Mailing address:
  • Phone: 218-722-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number31130
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: