Provider Demographics
NPI:1649845702
Name:STOKES, MARY (PHLEBOTOMIST)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:STOKES
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 DES PLAINES AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1271
Mailing Address - Country:US
Mailing Address - Phone:312-770-0418
Mailing Address - Fax:
Practice Address - Street 1:228 DES PLAINES AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1271
Practice Address - Country:US
Practice Address - Phone:312-770-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13-3591246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy