Healthcare Provider Details

I. General information

NPI: 1952986499
Provider Name (Legal Business Name): MARY GUILFOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE ML 7015
CINCINNATI OH
45229
US

IV. Provider business mailing address

148 HARRINGTON AVE
MADISON TN
37115-4018
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4266
  • Fax: 513-636-3549
Mailing address:
  • Phone: 859-653-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015795
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number026610
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: