Provider Demographics
NPI:1386764819
Name:MCGUIRE, MARY CLAIR (NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CLAIR
Last Name:MCGUIRE
Suffix:
Gender:
Credentials:NP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CLAIR
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:4801 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2015
Mailing Address - Country:US
Mailing Address - Phone:320-252-1670
Mailing Address - Fax:
Practice Address - Street 1:4801 VETERAN DRIVE
Practice Address - Street 2:
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-252-1670
Practice Address - Fax:320-255-6359
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100238208D00000X
MT17890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
411768149OtherMEDICARE ID