Individual provider Active NPI

Mary Leadith McNulty, N.P.

  • Nurse Practitioner
  • Canton, MI
National Provider Identifier
1730211194
Registry record updated May 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704196438 Issued in MI
Practice address
1051 N Canton Center Rd
Canton, MI 48187-5097
Phone
(734) 844-5400
NPI assigned
Mar 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Nurse Practitioner 363LC1500X 4704196438 MI
Primary Care Nurse Practitioner 363LP2300X 4704196438 MI
Nurse Practitioner 363L00000X 4704196438 MI Primary

Addresses

Primary practice location

1051 N Canton Center Rd
Canton, MI 48187-5097

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other identifiers 1

IdentifierTypeStateIssuer
4698876MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704196438MIMDPrimary Care Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557705600000",
    "number": "1730211194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 N CANTON CENTER RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481875097",
            "telephone_number": "734-844-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNULTY",
        "first_name": "MARY",
        "middle_name": "LEADITH",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2019-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "MI",
            "license": "4704196438",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704196438",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704196438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4698876",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.