Provider Demographics
NPI:1184449571
Name:ESPEJO, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ESPEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 LEGENDS DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-4404
Mailing Address - Country:US
Mailing Address - Phone:845-803-5746
Mailing Address - Fax:
Practice Address - Street 1:349 LEGENDS DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-4404
Practice Address - Country:US
Practice Address - Phone:845-803-5746
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
NY753731163W00000X
CT156664163W00000X
NC343160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse