Healthcare Provider Details

I. General information

NPI: 1023372414
Provider Name (Legal Business Name): MARY J HUFFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD SUITE G-14
LANSING MI
48910-6818
US

IV. Provider business mailing address

812 E JOLLY RD SUITE 210
LANSING MI
48910-6818
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8275
  • Fax: 517-346-8290
Mailing address:
  • Phone: 517-346-8223
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704275837
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: