Provider Demographics
NPI:1619062395
Name:MARY DALY MSN APRN BC INC
Entity Type:Organization
Organization Name:MARY DALY MSN APRN BC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN APRN BC
Authorized Official - Phone:989-791-1815
Mailing Address - Street 1:6321 NORMANDY DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7391
Mailing Address - Country:US
Mailing Address - Phone:989-791-1815
Mailing Address - Fax:989-791-1882
Practice Address - Street 1:6321 NORMANDY DR
Practice Address - Street 2:SUITE #4
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7391
Practice Address - Country:US
Practice Address - Phone:989-791-1815
Practice Address - Fax:989-791-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P27750Medicare ID - Type Unspecified