Healthcare Provider Details

I. General information

NPI: 1003263682
Provider Name (Legal Business Name): MARY LYN GUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W CHINCAPIN
WESTVILLE OK
74965
US

IV. Provider business mailing address

PO. 410
WESTVILLE OK
74965
US

V. Phone/Fax

Practice location:
  • Phone: 918-723-3181
  • Fax:
Mailing address:
  • Phone: 918-723-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: