Provider Demographics
NPI:1760085765
Name:HALE, MARY JULIA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JULIA
Last Name:HALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5876 RAVINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8598
Mailing Address - Country:US
Mailing Address - Phone:614-365-0370
Mailing Address - Fax:
Practice Address - Street 1:5876 RAVINE CREEK DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8598
Practice Address - Country:US
Practice Address - Phone:614-365-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker