Provider Demographics
NPI:1780904177
Name:MCKINDLES, MAUREEN KAY (RN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:KAY
Last Name:MCKINDLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3400 FOUR SEASONS DR
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-9465
Mailing Address - Country:US
Mailing Address - Phone:906-776-1809
Mailing Address - Fax:
Practice Address - Street 1:N3400 FOUR SEASONS DR
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-9465
Practice Address - Country:US
Practice Address - Phone:906-776-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI78303030163W00000X, 163WG0000X, 163WH0200X, 163WP0200X, 163WS0200X
MI4704128539163W00000X, 163WG0000X, 163WH0200X, 163WP0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WS0200XNursing Service ProvidersRegistered NurseSchool