Provider Demographics
NPI:1922320431
Name:UNICK, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:UNICK
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 1:206 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1302
Mailing Address - Country:US
Mailing Address - Phone:814-353-3151
Mailing Address - Fax:814-353-1876
Practice Address - Street 1:206 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1302
Practice Address - Country:US
Practice Address - Phone:814-353-3151
Practice Address - Fax:814-353-1876
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker