Provider Demographics
NPI:1427349273
Name:DENIUS, MARY EDITH (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:EDITH
Last Name:DENIUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EDYE
Other - Middle Name:
Other - Last Name:DENIUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:6230 HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-8416
Mailing Address - Country:US
Mailing Address - Phone:601-408-0916
Mailing Address - Fax:
Practice Address - Street 1:6230 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-8416
Practice Address - Country:US
Practice Address - Phone:601-408-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily