Provider Demographics
NPI:1386813905
Name:FINK, MARY JANE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:FINK
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 1:201 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-2919
Mailing Address - Country:US
Mailing Address - Phone:423-272-7641
Mailing Address - Fax:423-921-8073
Practice Address - Street 1:201 PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2919
Practice Address - Country:US
Practice Address - Phone:423-272-7641
Practice Address - Fax:423-921-8073
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator