Provider Demographics
NPI:1578845715
Name:DARLING, MARY BETH (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:DARLING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:SUSALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E RUSSELL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-2072
Mailing Address - Country:US
Mailing Address - Phone:517-424-3040
Mailing Address - Fax:517-423-0432
Practice Address - Street 1:200 E RUSSELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2072
Practice Address - Country:US
Practice Address - Phone:517-424-3040
Practice Address - Fax:517-423-0432
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28158861A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000750185OtherANTHEM
IN201048950Medicaid
INP01157054OtherMEDICARE RR
IN200917240AMedicaid
IN248790Medicare PIN
INM400065224Medicare PIN