Minielly, Mary Illig

Minielly, Mary Illig is an individual health care provider with primary practice located at 8100 S. Walker Avenue Building A, Oklahoma City OK 73139-9404. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Minielly, Mary Illig can be contacted via phone (405) 632-4468.

Contact Information

Primary practice address
8100 S. Walker Avenue Building A Oklahoma City OK 73139-9404
Phone: (405) 632-4468
Fax: (405) 631-4964
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R0059137 Oklahoma
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X R0059137 Oklahoma

Profile Details

NPI number 1417086380
LBN Legal business name Minielly, Mary Illig
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 5th, 2007
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1417086380 NPPES
Oklahoma Other 100130740A OHCA
Oklahoma Other 28812 OHCA
Oklahoma Other 100130740A OHCA
Oklahoma Other 12317438 OHCA
Oklahoma Other 1417086380 OHCA
Oklahoma Other 59137 OHCA

Popular Providers