=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124005426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY A PLATTNER N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2005
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2344 LAGUNA DEL MAR CT STE 104
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-3468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-847-6127
-----------------------------------------------------
Fax | 956-602-0562
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2344 LAGUNA DEL MAR CT STE 104
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-3468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-847-6127
-----------------------------------------------------
Fax | 956-765-3484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP113371
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------