Provider Demographics
NPI:1104267640
Name:SERVEY, MARY SUSAN (RN,MSN, MSA,B-C)
Entity type:Individual
Prefix:PROF
First Name:MARY
Middle Name:SUSAN
Last Name:SERVEY
Suffix:
Gender:F
Credentials:RN,MSN, MSA,B-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14565 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7726
Mailing Address - Country:US
Mailing Address - Phone:734-283-9315
Mailing Address - Fax:734-283-9315
Practice Address - Street 1:14565 SHENANDOAH DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7726
Practice Address - Country:US
Practice Address - Phone:734-283-9315
Practice Address - Fax:734-283-9315
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704099566174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator