MEDICARE: MS. MARY ALICE MCGINNIS CRNP

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
1	363L00000X	Nurse Practitioner	UP000296A	PA

General Provider Information

NPI Number	:	1639139645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ALICE MCGINNIS CRNP

Provider Business Mailing Address
First Line	:	1700 PEACH ST STE 200
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16501-2134
Country	:	US
Telephone Number	:	814-877-8140
Fax Number	:	814-877-8141

Provider Business Practice Location Address
First Line	:	1700 PEACH ST STE 200
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16501-2134
Country	:	US
Telephone Number	:	814-877-8140
Fax Number	:	814-877-8141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	12/23/2019

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