Provider Demographics
NPI:1952986499
Name:GUILFOYLE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GUILFOYLE
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 1:148 HARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4018
Mailing Address - Country:US
Mailing Address - Phone:859-653-9209
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:ML 7015
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4266
Practice Address - Fax:513-636-3549
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015795363LF0000X
OH026610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty