Provider Demographics
NPI:1467936757
Name:DAY, MARY INEZ (LVN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:INEZ
Last Name:DAY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-4104
Mailing Address - Country:US
Mailing Address - Phone:817-353-9866
Mailing Address - Fax:
Practice Address - Street 1:918 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-4104
Practice Address - Country:US
Practice Address - Phone:817-353-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192333164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164X00000XMedicaid