Provider Demographics
NPI:1053911719
Name:FRY, MARGARET THERESA (LPN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:THERESA
Last Name:FRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 CEDARVIEW ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5029
Mailing Address - Country:US
Mailing Address - Phone:231-527-5877
Mailing Address - Fax:
Practice Address - Street 1:4929 CEDARVIEW ST APT 2C
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5029
Practice Address - Country:US
Practice Address - Phone:231-527-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703119633164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse