Healthcare Provider Details

I. General information

NPI: 1891040234
Provider Name (Legal Business Name): MARY ANNE HUGHES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8390 SIX FORKS RD STE 201
RALEIGH NC
27615-3060
US

IV. Provider business mailing address

3829 FALLS RIVER AVE
RALEIGH NC
27614-7415
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-8730
  • Fax: 919-782-8730
Mailing address:
  • Phone: 919-376-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5005632
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: