Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Fannon

Individual provider Acute Care Nurse Practitioner · NPI 1043933518

Mary Fannon is a Nurse Practitioner in Philadelphia, Pennsylvania. Qualified in 2022, 4 years ago. Practices with Jefferson University Physicians, a 1,554-clinician group and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
4
Licensed in
PA
In the registry since
2022
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Practice location Address checks out

111 S 11th St
Philadelphia, PA 19107-4824
Phone: (215) 955-6060
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence SP026285 (PA)

Record details

NPI number1043933518
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 20, 2022
Last updated in NPPESSeptember 20, 2022
Certification dateSeptember 19, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Jefferson University Physicians — 1554 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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