Provider Demographics
NPI:1366592115
Name:NEJEDLY, MAUREEN DEVANEY (FNP)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:DEVANEY
Last Name:NEJEDLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:3225 SHALLOWFORD RD
Mailing Address - Street 2:BUILDING 1300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1266
Mailing Address - Country:US
Mailing Address - Phone:678-560-7160
Mailing Address - Fax:678-560-7185
Practice Address - Street 1:3225 SHALLOWFORD RD
Practice Address - Street 2:BUILDING 1300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1266
Practice Address - Country:US
Practice Address - Phone:678-560-7160
Practice Address - Fax:678-560-7185
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN057680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN057680OtherNURSING LICENSE