Provider Demographics
NPI:1700076684
Name:HOOPER, MARY KAY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:HOOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KAY
Other - Last Name:DENOFRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 COUNTY ROAD PPL
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-9050
Mailing Address - Country:US
Mailing Address - Phone:906-486-4315
Mailing Address - Fax:
Practice Address - Street 1:1000 COUNTY ROAD PPL
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-9050
Practice Address - Country:US
Practice Address - Phone:906-486-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244897163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse