Provider Demographics
NPI:1760552582
Name:AYERS, MARY KAY (CNM)
Entity Type:Individual
Prefix:MS
First Name:MARY KAY
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:CNM
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 465
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60421-0465
Mailing Address - Country:US
Mailing Address - Phone:815-423-5405
Mailing Address - Fax:
Practice Address - Street 1:ST. ANTHONY HOSPITAL
Practice Address - Street 2:2875 W. 19TH STREET
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623
Practice Address - Country:US
Practice Address - Phone:773-484-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004150367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL962320Medicare ID - Type Unspecified