Provider Demographics
NPI:1225366479
Name:PHIFER, MARY JANE (CNM, MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:PHIFER
Suffix:
Gender:F
Credentials:CNM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 38
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65704-9650
Mailing Address - Country:US
Mailing Address - Phone:417-554-1210
Mailing Address - Fax:
Practice Address - Street 1:1032 KINGSHIGHWAY ST
Practice Address - Street 2:B
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2921
Practice Address - Country:US
Practice Address - Phone:573-364-1509
Practice Address - Fax:573-364-6520
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018551367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife