Provider Demographics
NPI:1497883375
Name:GOLUBSKI, MARY C (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:GOLUBSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:PRIESTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:901 MACARTHUR BOULEVARD
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2901
Mailing Address - Country:US
Mailing Address - Phone:219-836-7040
Mailing Address - Fax:219-513-1127
Practice Address - Street 1:901 MACARTHUR BOULEVARD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2901
Practice Address - Country:US
Practice Address - Phone:219-836-1600
Practice Address - Fax:219-513-1127
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28149952A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200332010AMedicaid
IN000000192506OtherANTHEM BCBS
IN000000192506OtherANTHEM BCBS