Provider Demographics
NPI:1164988929
Name:MCBRIDE, MALARY KAY (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:MALARY
Middle Name:KAY
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1506
Mailing Address - Country:US
Mailing Address - Phone:419-233-0435
Mailing Address - Fax:
Practice Address - Street 1:559 HARMON RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1085
Practice Address - Country:US
Practice Address - Phone:419-358-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024256363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health