Provider Demographics
NPI:1215346366
Name:HAERER, MARY MAY (APRN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MARY MAY
Middle Name:
Last Name:HAERER
Suffix:
Gender:F
Credentials:APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:MARY MAY
Other - Middle Name:
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, AGPCNP-BC
Mailing Address - Street 1:191 LOWER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-9402
Mailing Address - Country:US
Mailing Address - Phone:413-625-9300
Mailing Address - Fax:
Practice Address - Street 1:191 LOWER ST
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370-9402
Practice Address - Country:US
Practice Address - Phone:413-625-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2292514363LG0600X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care