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General NPI Number Information
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NPI Number | 1154004729
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Entity Type | Individual
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Provider Name | MILDRED W HORVATH RN
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 16103 CARNOUSTIE LN
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City | VLG LOCH LOYD
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State | MO
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Zip | 64012-5503
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Country | US
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Telephone | 913-206-5048
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Fax |
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Provider Business Mailing Address
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Address Line | 16103 CARNOUSTIE LN
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City | VLG LOCH LOYD
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State | MO
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Zip | 64012-5503
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Country | US
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Telephone | 913-206-5048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN1003X
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Taxonomy Name | Nutrition Support Registered Nurse
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License Number | 098993
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License Number State | MO
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