Provider Demographics
NPI:1609967454
Name:THOTTAM, MARY R (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:THOTTAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:R
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5917 PLEASANT WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2765
Mailing Address - Country:US
Mailing Address - Phone:817-451-0599
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:5917 PLEASANT WOOD TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2765
Practice Address - Country:US
Practice Address - Phone:817-451-0599
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2581032363LF0000X
TX579774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily