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1962980979 NPI number — MARY ELIZABETH PAGANO FNP-C

NPI Number: 1962980979
Health Care Provider/Practitioner: MARY ELIZABETH PAGANO FNP-C

Information about “1962980979” NPI (MARY ELIZABETH PAGANO FNP-C) exists in 1962980979 in HTML format HTML  |  1962980979 in plain Text format TXT  |  1962980979 in PDF (Portable Document Format) PDF  |  1962980979 in an XML format XML  formats.

NPI Number : 1962980979 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962980979",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PAGANO",
    "FirstName": "MARY",
    "MiddleName": "ELIZABETH",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "FNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "660 MASON RIDGE CENTER DR STE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63141-8512",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-448-3791",
    "MailingAddressFaxNumber": "314-996-7658",
    "FirstLinePracticeLocationAddress": "5213 GODFREY RD STE 110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GODFREY",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62035-2510",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-618-6193",
    "PracticeLocationAddressFaxNumber": "618-619-3390",
    "EnumerationDate": "08/01/2018",
    "LastUpdateDate": "09/19/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "209017735",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "2018012503",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WG0000X",
          "TaxonomyName": "General Practice Registered Nurse",
          "LicenseNumber": "041453981",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WG0000X",
          "TaxonomyName": "General Practice Registered Nurse",
          "LicenseNumber": "2002007982",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "209017735",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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