Provider Demographics
NPI:1326665142
Name:TODD, MARY ANN (AGNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:TODD
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Gender:F
Credentials:AGNP
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Mailing Address - Street 1:24420 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:WAGRAM
Mailing Address - State:NC
Mailing Address - Zip Code:28396-9600
Mailing Address - Country:US
Mailing Address - Phone:910-369-3136
Mailing Address - Fax:910-504-8515
Practice Address - Street 1:24420 MARLBORO ST
Practice Address - Street 2:
Practice Address - City:WAGRAM
Practice Address - State:NC
Practice Address - Zip Code:28396-9600
Practice Address - Country:US
Practice Address - Phone:910-369-3136
Practice Address - Fax:910-504-8515
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2024-11-13
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Provider Licenses
StateLicense IDTaxonomies
NC5014125207Q00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine