Provider Demographics
NPI:1487197174
Name:SATTERWHITE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SATTERWHITE
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 1:710 REDBUD
Mailing Address - Street 2:
Mailing Address - City:TOW
Mailing Address - State:TX
Mailing Address - Zip Code:78672-4919
Mailing Address - Country:US
Mailing Address - Phone:361-815-2807
Mailing Address - Fax:
Practice Address - Street 1:710 REDBUD
Practice Address - Street 2:
Practice Address - City:TOW
Practice Address - State:TX
Practice Address - Zip Code:78672-4919
Practice Address - Country:US
Practice Address - Phone:361-815-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily