Provider Demographics
NPI:1720825508
Name:MAYLE, MARY R
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:MAYLE
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 1:4997 WEBSTER PIKE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-7657
Mailing Address - Country:US
Mailing Address - Phone:740-532-1813
Mailing Address - Fax:
Practice Address - Street 1:4997 WEBSTER PIKE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-7657
Practice Address - Country:US
Practice Address - Phone:740-532-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker