Provider Demographics
NPI:1619588191
Name:MICHAELS, MARY KATHERINE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:MICHAELS
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 1:23668 MCMULLEN HWY SW
Mailing Address - Street 2:
Mailing Address - City:RAWLINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21557-2440
Mailing Address - Country:US
Mailing Address - Phone:301-707-2852
Mailing Address - Fax:
Practice Address - Street 1:23668 MCMULLEN HWY SW
Practice Address - Street 2:
Practice Address - City:RAWLINGS
Practice Address - State:MD
Practice Address - Zip Code:21557-2440
Practice Address - Country:US
Practice Address - Phone:301-707-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant