Provider Demographics
NPI:1972890697
Name:MCCORMICK, MARY LOUISE (DVM)
Entity Type:Individual
Prefix:DR
First Name:MARY LOUISE
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17193 GARDEN GROVE RD SE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-9132
Mailing Address - Country:US
Mailing Address - Phone:763-262-1268
Mailing Address - Fax:
Practice Address - Street 1:2503 37TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4214
Practice Address - Country:US
Practice Address - Phone:612-781-2734
Practice Address - Fax:612-789-2499
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10494174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian