Provider Demographics
NPI:1487725958
Name:CAFFEE, MARY JANNICE (CFNP, ND)
Entity type:Individual
Prefix:MR
First Name:MARY
Middle Name:JANNICE
Last Name:CAFFEE
Suffix:
Gender:F
Credentials:CFNP, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 11479
Mailing Address - Street 2:3-6C BONNE ESPERANCE
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801
Mailing Address - Country:US
Mailing Address - Phone:340-774-0315
Mailing Address - Fax:340-776-7424
Practice Address - Street 1:MEIJER
Practice Address - Street 2:2507 CHESTER ROAD
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374
Practice Address - Country:US
Practice Address - Phone:765-939-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI6173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily