Healthcare Provider Details

I. General information

NPI: 1831469006
Provider Name (Legal Business Name): LOUISE M. CUPIT L.V.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S MAIN ST ROOM 1600
FORT WORTH TX
76104-4802
US

IV. Provider business mailing address

1101 S. MAIN STREET ROOM 1600
FORT WORTH TX
76104
US

V. Phone/Fax

Practice location:
  • Phone: 817-321-4952
  • Fax: 817-850-8511
Mailing address:
  • Phone: 817-321-4952
  • Fax: 817-850-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number90072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: