Provider Demographics
NPI:1104112614
Name:HUNT, MARY JANE (CNA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:HUNT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4164 LAKE CREST CIR
Mailing Address - Street 2:APT 2 B
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-7607
Mailing Address - Country:US
Mailing Address - Phone:269-779-7234
Mailing Address - Fax:
Practice Address - Street 1:4164 LAKE CREST CIR
Practice Address - Street 2:APT 2 B
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-7607
Practice Address - Country:US
Practice Address - Phone:269-779-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI239363171090376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide