Healthcare Provider Details

I. General information

NPI: 1093113045
Provider Name (Legal Business Name): MARY CATHERINE HANNIGAN-CONROY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIS GROVE WAY
GLEN MILLS PA
19342-1282
US

IV. Provider business mailing address

5525 RESEARCH PARK DR 4TH FLOOR
BALTIMORE MD
21228-4873
US

V. Phone/Fax

Practice location:
  • Phone: 610-387-4520
  • Fax: 610-387-4526
Mailing address:
  • Phone: 610-387-4520
  • Fax: 610-387-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberVP004217C
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN296185L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: