Provider Demographics
NPI:1306904792
Name:DUGAN, MARY ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:DUGAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-2005
Mailing Address - Country:US
Mailing Address - Phone:215-233-4452
Mailing Address - Fax:
Practice Address - Street 1:LA SALLE UNIVERSITY 1900 WEST OLNEY AVE.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1199
Practice Address - Country:US
Practice Address - Phone:215-951-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPOO7562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily