Provider Demographics
NPI:1558576033
Name:GAY, MARY MARGARET (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:GAY
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 1:136 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2328
Mailing Address - Country:US
Mailing Address - Phone:715-861-3142
Mailing Address - Fax:715-723-5564
Practice Address - Street 1:136 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2328
Practice Address - Country:US
Practice Address - Phone:715-861-3142
Practice Address - Fax:715-723-5564
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38210600Medicare ID - Type UnspecifiedPROVIDER ID