Provider Demographics
NPI:1538702113
Name:ACY, MARY WILCOX (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WILCOX
Last Name:ACY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BRADLEY PL
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2221
Mailing Address - Country:US
Mailing Address - Phone:504-451-3492
Mailing Address - Fax:
Practice Address - Street 1:118 BRADLEY PL
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2221
Practice Address - Country:US
Practice Address - Phone:504-451-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA127424163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult