Provider Demographics
NPI:1326694027
Name:ZODY, MARY (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ZODY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:IN
Mailing Address - Zip Code:46926-0124
Mailing Address - Country:US
Mailing Address - Phone:765-437-9655
Mailing Address - Fax:
Practice Address - Street 1:8177 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IN
Practice Address - Zip Code:46926-2328
Practice Address - Country:US
Practice Address - Phone:765-437-9655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28064048A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health