1114250263 NPI number — MRS. MARY RYAN DROUILLARD R.N.

Table of content: MRS. MARY RYAN DROUILLARD R.N. (NPI 1114250263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114250263 NPI number — MRS. MARY RYAN DROUILLARD R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DROUILLARD
Provider First Name:
MARY
Provider Middle Name:
RYAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RYAN
Provider Other First Name:
MARY
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114250263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49688-0416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-829-3624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CADILLAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49601-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-775-0101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  4704160220 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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