Provider Demographics
NPI:1881773885
Name:MCILHON, MARY JO (DOM)
Entity type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:MCILHON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SALAZAR ST
Mailing Address - Street 2:FRONT
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-3641
Mailing Address - Country:US
Mailing Address - Phone:505-984-8877
Mailing Address - Fax:
Practice Address - Street 1:521 SALAZAR ST
Practice Address - Street 2:FRONT
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-3641
Practice Address - Country:US
Practice Address - Phone:505-984-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM714171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist