Healthcare Provider Details

I. General information

NPI: 1720249253
Provider Name (Legal Business Name): MARY MARGARET RAE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S 4TH ST
WEST NEWTON PA
15089-1315
US

IV. Provider business mailing address

219 S 4TH ST
WEST NEWTON PA
15089-1315
US

V. Phone/Fax

Practice location:
  • Phone: 724-872-6727
  • Fax:
Mailing address:
  • Phone: 724-872-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN-271519L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: