Provider Demographics
NPI:1639923535
Name:MCQUARY, DARRELL CLARK
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:CLARK
Last Name:MCQUARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 CHEYENNE TRL
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45335-1116
Mailing Address - Country:US
Mailing Address - Phone:937-974-4687
Mailing Address - Fax:
Practice Address - Street 1:4022 CHEYENNE TRL
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:OH
Practice Address - Zip Code:45335-1116
Practice Address - Country:US
Practice Address - Phone:937-974-4687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker