Provider Demographics
NPI:1851378939
Name:GULLION, MARY MICHELE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELE
Last Name:GULLION
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 86236
Mailing Address - Street 2:PO BOX 950195
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0195
Mailing Address - Country:US
Mailing Address - Phone:502-473-2100
Mailing Address - Fax:502-459-6461
Practice Address - Street 1:ONE AUDUBON PLAZA
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-636-7449
Practice Address - Fax:502-636-7950
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2189A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74468752Medicaid
KY00546211Medicare Oscar/Certification
KY74468752Medicaid