Provider Demographics
NPI:1285053314
Name:VERMILLION, MARY (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:VERMILLION
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2667
Mailing Address - Country:US
Mailing Address - Phone:406-880-2551
Mailing Address - Fax:
Practice Address - Street 1:1404 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2315
Practice Address - Country:US
Practice Address - Phone:406-532-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT72629163WP0809X, 163WL0100X, 163WW0101X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163W00000XNursing Service ProvidersRegistered Nurse