Healthcare Provider Details

I. General information

NPI: 1275512816
Provider Name (Legal Business Name): MARY HEGARTY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOSPITAL DR SUITE 312
LEWISBURG PA
17837-9362
US

IV. Provider business mailing address

3 HOSPITAL DR SUITE 312
LEWISBURG PA
17837-9362
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-8700
  • Fax: 570-513-8705
Mailing address:
  • Phone: 570-523-8700
  • Fax: 570-513-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberTP 001766G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: