Provider Demographics
NPI:1790597557
Name:PIETRAS, MARY ELIZABETH (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:PIETRAS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 LAPORTE RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626-9508
Mailing Address - Country:US
Mailing Address - Phone:989-213-5210
Mailing Address - Fax:
Practice Address - Street 1:2137 LAPORTE RD
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-9508
Practice Address - Country:US
Practice Address - Phone:989-213-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704323588363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health