Healthcare Provider Details

I. General information

NPI: 1417958711
Provider Name (Legal Business Name): MARY ANN MCGUIRE CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 S UNION AVE
ROSWELL NM
88203-2656
US

IV. Provider business mailing address

1717 W 2ND ST STE 101
ROSWELL NM
88201-2000
US

V. Phone/Fax

Practice location:
  • Phone: 575-208-0106
  • Fax: 575-208-0700
Mailing address:
  • Phone: 575-627-1200
  • Fax: 888-445-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR38408
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: