Mary Lou Fellows

Primary specialty

Adult CompanionTaxonomy code 372600000X

License

1054348 AFC Issued in MN

Practice address

14275 N County Road 24
Wabasha, MN 55981-7536

Phone

(651) 560-2111

NPI assigned

Sep 19, 2012

Last updated

Sep 19, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1093066847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 N COUNTY ROAD 24",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559817536",
            "telephone_number": "651-560-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14275 N COUNTY ROAD 24",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559817536",
            "telephone_number": "651-560-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELLOWS",
        "first_name": "MARY",
        "middle_name": "LOU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "MN",
            "license": "1054348 AFC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Companion in Wabasha, MN
• Providers in Wabasha, MN by specialty
• Adult Companion in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.