Provider Demographics
NPI:1437169471
Name:MCKINNEY, MARY E (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:E
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 GILEAD ST
Mailing Address - Street 2:LOT 1
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:229 GILEAD ST
Practice Address - Street 2:LOT 1
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9523
Practice Address - Country:US
Practice Address - Phone:419-864-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0956765376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide