Provider Demographics
NPI:1295141760
Name:HOWLETT, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HOWLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-0633
Mailing Address - Country:US
Mailing Address - Phone:417-847-5546
Mailing Address - Fax:417-847-8826
Practice Address - Street 1:71 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-1755
Practice Address - Country:US
Practice Address - Phone:417-847-5546
Practice Address - Fax:417-847-8826
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040818310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility