Provider Demographics
NPI:1457994105
Name:MCELROY, MARY ANNE KEHAULANI
Entity type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:KEHAULANI
Last Name:MCELROY
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:25106-0129
Mailing Address - Country:US
Mailing Address - Phone:910-723-8020
Mailing Address - Fax:
Practice Address - Street 1:2435 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:WV
Practice Address - Zip Code:25106
Practice Address - Country:US
Practice Address - Phone:910-723-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVHS0182335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier