Provider Demographics
NPI:1043505431
Name:BOATWRIGHT, MARY PATIRICA (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:PATIRICA
Last Name:BOATWRIGHT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:PATIRICA
Other - Last Name:FUHRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:122 W BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9320
Mailing Address - Country:US
Mailing Address - Phone:989-283-1172
Mailing Address - Fax:989-283-1172
Practice Address - Street 1:122 W BRADFORD ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9320
Practice Address - Country:US
Practice Address - Phone:989-283-1172
Practice Address - Fax:989-283-1172
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704191953163WH0200X
WI126428-30163WH0200X
FLRN 9291185163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health