Provider Demographics
NPI:1609499011
Name:SCHALLENBERGER, MARY C (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:SCHALLENBERGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USNMRTC YOKOSUKA
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96349-0020
Mailing Address - Country:US
Mailing Address - Phone:315-243-8597
Mailing Address - Fax:
Practice Address - Street 1:USNMRTC YOKOSUKA
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96349
Practice Address - Country:US
Practice Address - Phone:315-243-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0191845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily