Provider Demographics
NPI:1316285299
Name:NEMEC, MARY JO (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:NEMEC
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19757 327TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLABIRD
Mailing Address - State:SD
Mailing Address - Zip Code:57540-5412
Mailing Address - Country:US
Mailing Address - Phone:605-852-2385
Mailing Address - Fax:
Practice Address - Street 1:603 S DAKOTA ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-2812
Practice Address - Country:US
Practice Address - Phone:605-554-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily