Provider Demographics
NPI:1124005426
Name:PLATTNER, MARY A (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:PLATTNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-0698
Mailing Address - Country:US
Mailing Address - Phone:956-765-5847
Mailing Address - Fax:956-765-3484
Practice Address - Street 1:1201 N HWY 83
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076
Practice Address - Country:US
Practice Address - Phone:956-765-5847
Practice Address - Fax:956-765-3484
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX555414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00187384OtherRAILROAD MEDICARE
TX170761401Medicaid
TX8C8944Medicare PIN
TXP00187384OtherRAILROAD MEDICARE