MARY S BANNON NP NPI 1043392590

NPI Information

  • NPI: 1043392590
  • Provider Name: MARY S BANNON, NP
  • Classification: Nurse Practitioner - 363LG0600X
  • Specialization: Gerontology
  • Entity Type: Individual
  • Address: 671 MAIN ST
    WALTHAM, MA
    ZIP 02451
  • Phone: (781) 647-3040

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NPI Details

Mary S Bannon, NP is a gerontology nurse practitioner in Waltham, MA. Mary S Bannon, NP NPI is 1043392590. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

671 MAIN ST
WALTHAM, MA
ZIP 02451-602
Phone: (781) 647-3040
Fax: (781) 647-3044

The enumeration date for this NPI number is 10/20/2006 and was last updated on 7/28/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LG0600XNurse PractitionerGerontology158347MASSACHUSETTSYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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