Provider Demographics
NPI:1679668313
Name:DALY, MARY ELIZABETH (DNP PMHNP-BC, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:DALY
Suffix:
Gender:F
Credentials:DNP PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 SHATTUCK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3287
Mailing Address - Country:US
Mailing Address - Phone:989-244-0090
Mailing Address - Fax:989-355-1074
Practice Address - Street 1:3350 SHATTUCK RD STE 3
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3287
Practice Address - Country:US
Practice Address - Phone:989-442-0090
Practice Address - Fax:989-355-1074
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704122721363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008757500OtherBCBS MICHIGAN
MI4835320Medicaid
MIP27750001Medicare PIN
MI0N88550Medicare PIN
MI4835320Medicaid
MIN88550004Medicare PIN