Provider Demographics
NPI:1417448358
Name:ATILLO, MARY CLEMENT
Entity Type:Individual
Prefix:PROF
First Name:MARY
Middle Name:CLEMENT
Last Name:ATILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 NELSON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-7238
Mailing Address - Country:US
Mailing Address - Phone:956-522-8038
Mailing Address - Fax:
Practice Address - Street 1:5604 NELSON OAKS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-7238
Practice Address - Country:US
Practice Address - Phone:956-533-8038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233296164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse