Healthcare Provider Details

I. General information

NPI: 1942412671
Provider Name (Legal Business Name): MARILYN R LOUTHER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CYPRESS CIR ST.
HUNTSVILLE TX
77320-3046
US

IV. Provider business mailing address

124 CYPRESS CIR
HUNTSVILLE TX
77320-3046
US

V. Phone/Fax

Practice location:
  • Phone: 936-295-0604
  • Fax:
Mailing address:
  • Phone: 936-295-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number217261
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number217261
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: