Individual
MARY NELL ANKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
110 10TH ST SE, BANDON, OR 97411-9157
(541) 347-2313
(541) 347-2015
Mailing address
110 10TH ST SE, BANDON, OR 97411-9157
(541) 347-2313
(541) 347-2015
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200950121NP
OR
363LA2200X
Adult Health Nurse Practitioner
200950121NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01948232
—
NY
01
—
1407812365
NBMC GROUP NPI NUMBER
OR
01
—
161133
NBMC GROUP MEDICAID NUMBER
OR
01
—
930635514
NBMC GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
NBMC GROUP MEDICARE NUMBER
OR
Enumeration date
10/14/2005
Last updated
05/20/2013
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