Provider Demographics
NPI:1972878742
Name:HORST, ROSE MARY (CPM, LM)
Entity Type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:MARY
Last Name:HORST
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 COUNTY ROAD 4653
Mailing Address - Street 2:
Mailing Address - City:TIMPSON
Mailing Address - State:TX
Mailing Address - Zip Code:75975-5167
Mailing Address - Country:US
Mailing Address - Phone:817-666-8076
Mailing Address - Fax:
Practice Address - Street 1:1687 COUNTY ROAD 4653
Practice Address - Street 2:
Practice Address - City:TIMPSON
Practice Address - State:TX
Practice Address - Zip Code:75975-5167
Practice Address - Country:US
Practice Address - Phone:817-666-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99136176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife