Healthcare Provider Details

I. General information

NPI: 1861772402
Provider Name (Legal Business Name): MARA ANNE SAUNDERS RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BLEECKER ST # 151
NEW YORK NY
10012-2410
US

IV. Provider business mailing address

64 BLEECKER ST # 151
NEW YORK NY
10012-2410
US

V. Phone/Fax

Practice location:
  • Phone: 302-313-1584
  • Fax:
Mailing address:
  • Phone: 302-313-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5015498
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number683207
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number20615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: