Provider Demographics
NPI:1194010413
Name:GUY-DIAL, MARY LORRAINE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LORRAINE
Last Name:GUY-DIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 GATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3325
Mailing Address - Country:US
Mailing Address - Phone:903-714-4544
Mailing Address - Fax:
Practice Address - Street 1:411 GATEWOOD DR
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3325
Practice Address - Country:US
Practice Address - Phone:903-714-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other