Provider Demographics
NPI:1891838975
Name:CROUTHERS, MARY JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JEAN
Last Name:CROUTHERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 QUINCO DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1705
Mailing Address - Country:US
Mailing Address - Phone:731-989-7108
Mailing Address - Fax:731-989-9686
Practice Address - Street 1:301 QUINCO DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1705
Practice Address - Country:US
Practice Address - Phone:731-989-7108
Practice Address - Fax:731-989-9686
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse