Provider Demographics
NPI:1730781204
Name:HRUBY, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HRUBY
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 1:608 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ND
Mailing Address - Zip Code:58579-7129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ND
Practice Address - Zip Code:58579-7129
Practice Address - Country:US
Practice Address - Phone:701-734-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant