MEDICARE: MILDRED W HORVATH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WN1003X	Nutrition Support Registered Nurse	098993	MO

General Provider Information

NPI Number	:	1154004729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDRED W HORVATH RN

Provider Business Mailing Address
First Line	:	16103 CARNOUSTIE LN
Second Line	:
City	:	VLG LOCH LOYD
State	:	MO
Zip	:	64012-5503
Country	:	US
Telephone Number	:	913-206-5048
Fax Number	:

Provider Business Practice Location Address
First Line	:	16103 CARNOUSTIE LN
Second Line	:
City	:	VLG LOCH LOYD
State	:	MO
Zip	:	64012-5503
Country	:	US
Telephone Number	:	913-206-5048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	08/10/2023

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