Provider Demographics
NPI:1043343346
Name:DUGAN, MARY C (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:DUGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 S LA FRENZ RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-8352
Mailing Address - Country:US
Mailing Address - Phone:816-781-4178
Mailing Address - Fax:
Practice Address - Street 1:9784 N ASH AVENUE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157
Practice Address - Country:US
Practice Address - Phone:816-781-4244
Practice Address - Fax:816-781-3542
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO092099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA110171OtherIOWA ADVANCED NURSING LICENSE