Provider Demographics
NPI:1255894606
Name:THORPE, MARY KATHERINE (LVN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:THORPE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 RUFFIAN WAY
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75087-6930
Mailing Address - Country:US
Mailing Address - Phone:936-827-7388
Mailing Address - Fax:
Practice Address - Street 1:786 RUFFIAN WAY
Practice Address - Street 2:
Practice Address - City:FATE
Practice Address - State:TX
Practice Address - Zip Code:75087-6930
Practice Address - Country:US
Practice Address - Phone:936-827-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77869164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse