Provider Demographics
NPI:1831469006
Name:CUPIT, LOUISE M (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:M
Last Name:CUPIT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S. MAIN STREET
Mailing Address - Street 2:ROOM 1600
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-321-4952
Mailing Address - Fax:817-850-8511
Practice Address - Street 1:1101 S MAIN ST
Practice Address - Street 2:ROOM 1600
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4802
Practice Address - Country:US
Practice Address - Phone:817-321-4952
Practice Address - Fax:817-850-8511
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90072164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse