Healthcare Provider Details

I. General information

NPI: 1265981468
Provider Name (Legal Business Name): MARY ELIZABETH GAINES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4464 S DIXIE HWY
MIDDLETOWN OH
45005-5464
US

IV. Provider business mailing address

4464 S DIXIE HWY
MIDDLETOWN OH
45005-5464
US

V. Phone/Fax

Practice location:
  • Phone: 513-649-8008
  • Fax: 513-649-8004
Mailing address:
  • Phone: 513-649-8008
  • Fax: 513-649-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.254604
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: