Provider Demographics
NPI:1023833464
Name:PEDERSEN, MARY JOAN BARNES (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOAN BARNES
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:BARNES
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1882 IRON CITY AVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLS
Mailing Address - State:IA
Mailing Address - Zip Code:52766-9549
Mailing Address - Country:US
Mailing Address - Phone:309-737-3325
Mailing Address - Fax:
Practice Address - Street 1:1882 IRON CITY AVE
Practice Address - Street 2:
Practice Address - City:NICHOLS
Practice Address - State:IA
Practice Address - Zip Code:52766-9549
Practice Address - Country:US
Practice Address - Phone:309-737-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA181930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine