Provider Demographics
NPI:1215992805
Name:MCGUIRE, MARY H (APN,BC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:APN,BC
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:HAUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 BROADWAY AVE E
Mailing Address - Street 2:SUITE 39
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4671
Mailing Address - Country:US
Mailing Address - Phone:217-234-3091
Mailing Address - Fax:217-234-3094
Practice Address - Street 1:700 BROADWAY AVE E
Practice Address - Street 2:SUITE 39
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4671
Practice Address - Country:US
Practice Address - Phone:217-234-3091
Practice Address - Fax:217-234-3094
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily