Provider Demographics
NPI:1639582414
Name:ADY, MARY (BSN, RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ADY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:555 NORTH MAIN
Mailing Address - City:JUNCTION
Mailing Address - State:UT
Mailing Address - Zip Code:84740-0040
Mailing Address - Country:US
Mailing Address - Phone:435-577-2521
Mailing Address - Fax:435-577-2521
Practice Address - Street 1:70 W WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1868
Practice Address - Country:US
Practice Address - Phone:435-577-2521
Practice Address - Fax:435-577-2521
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT220974-3102163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics