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NPI Code Detail

MEDICARE: MARY E. WARDLAW N.P.

MEDICARE: MARY E. WARDLAW N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner7899CA
2363LF0000XFamily Nurse Practitioner7899CA

General Provider Information

NPI Number : 1275626384
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E. WARDLAW N.P.
Provider Business Mailing Address
First Line : 500 SAN PABLO AVE
Second Line :
City : ALBANY
State : CA
Zip : 94706-1103
Country : US
Telephone Number : 510-204-8130
Fax Number : 510-524-0861
Provider Business Practice Location Address
First Line : 500 SAN PABLO AVE
Second Line :
City : ALBANY
State : CA
Zip : 94706-1103
Country : US
Telephone Number : 510-204-8130
Fax Number : 510-524-0861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 10/30/2017

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Directions to “ MARY E. WARDLAW N.P.” Practice Location

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