Individual
MARY KATHRYN CHASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
44199 DEQUINDRE RD STE 618, TROY, MI 48085-1128
(248) 964-3928
(248) 964-1464
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704216248
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704216248
RN LICENSE
MI
Enumeration date
08/13/2009
Last updated
07/19/2022
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