Healthcare Provider Details

I. General information

NPI: 1184995631
Provider Name (Legal Business Name): MARY GYURE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2012
Last Update Date: 01/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 LINCOLNWAY
VALPARAISO IN
46383-5727
US

IV. Provider business mailing address

607 LINCOLNWAY
VALPARAISO IN
46383-5727
US

V. Phone/Fax

Practice location:
  • Phone: 219-548-8727
  • Fax: 219-465-7211
Mailing address:
  • Phone: 219-548-8727
  • Fax: 219-465-7211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33005975A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: