Provider Demographics
NPI:1427321629
Name:WHITE, MARY KAY (STNA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:KAY
Other - Last Name:HOLDSWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1013 AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6903
Mailing Address - Country:US
Mailing Address - Phone:740-223-2818
Mailing Address - Fax:
Practice Address - Street 1:1013 AMHERST DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6903
Practice Address - Country:US
Practice Address - Phone:740-223-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401263120611374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide