Provider Demographics
NPI:1477101566
Name:HORSTING, ELSIE MAE (INDIVIDUAL PROVIDER)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:MAE
Last Name:HORSTING
Suffix:
Gender:F
Credentials:INDIVIDUAL PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10679 US HIGHWAY 231 SOUTH
Mailing Address - Street 2:10679 US HWY 231 SOUTH
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-4952
Mailing Address - Country:US
Mailing Address - Phone:812-295-4680
Mailing Address - Fax:
Practice Address - Street 1:10679 US HIGHWAY 231 SOUTH
Practice Address - Street 2:10679 US HWY 231 SOUTH
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-4952
Practice Address - Country:US
Practice Address - Phone:812-295-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider