Basic Information
| Provider Information | |||||||||
| NPI: | 1417249376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAREZ | ||||||||
| FirstName: | MARYE | ||||||||
| MiddleName: | CYNTHIA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | C.R.N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PHAREZ | ||||||||
| OtherFirstName: | CINDY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 SCHAUB AVE | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366095131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513777363 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5750A SOUTHLAND DR | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366933316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514505900 | ||||||||
| FaxNumber: | 2516627297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 1052638 | AL | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.