Provider Demographics
NPI:1740746080
Name:QUICK ISTRE, MACIE
Entity Type:Individual
Prefix:
First Name:MACIE
Middle Name:
Last Name:QUICK ISTRE
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 1:285 FELTS ST
Mailing Address - Street 2:
Mailing Address - City:HEMPHILL
Mailing Address - State:TX
Mailing Address - Zip Code:75948-7417
Mailing Address - Country:US
Mailing Address - Phone:936-201-7624
Mailing Address - Fax:
Practice Address - Street 1:285 FELTS ST
Practice Address - Street 2:
Practice Address - City:HEMPHILL
Practice Address - State:TX
Practice Address - Zip Code:75948-7417
Practice Address - Country:US
Practice Address - Phone:936-201-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346884164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse