Provider Demographics
NPI:1588875710
Name:CARY, MILDRED MAXINE
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:MAXINE
Last Name:CARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-9759
Mailing Address - Country:US
Mailing Address - Phone:870-423-2985
Mailing Address - Fax:
Practice Address - Street 1:352 WILSON DR
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-9759
Practice Address - Country:US
Practice Address - Phone:870-423-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider