Provider Demographics
NPI:1881940328
Name:MACINNES, MARY CLAIRE (WHNP-BC, MSN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CLAIRE
Last Name:MACINNES
Suffix:
Gender:F
Credentials:WHNP-BC, MSN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CLAIRE
Other - Last Name:STOCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 W ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5194
Mailing Address - Country:US
Mailing Address - Phone:989-832-6769
Mailing Address - Fax:
Practice Address - Street 1:220 W ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5194
Practice Address - Country:US
Practice Address - Phone:989-832-6769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704183515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704183515OtherSTATE LICENSE