Provider Demographics
NPI:1174731103
Name:MCCARTHY, MARY T (APN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:T
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:1143 E FOX CHASE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4155
Mailing Address - Country:US
Mailing Address - Phone:847-231-5485
Mailing Address - Fax:
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:FEINBERG PAVILLION 4-508
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003341163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy