Provider Demographics
NPI:1265577324
Name:LA TORRE, MARY ANNE (RN,)
Entity type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:LA TORRE
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 1:31546 SASSAFRAS RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:MD
Mailing Address - Zip Code:21635-1349
Mailing Address - Country:US
Mailing Address - Phone:410-648-5884
Mailing Address - Fax:410-648-5764
Practice Address - Street 1:31546 SASSAFRAS RIVER AVE
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:MD
Practice Address - Zip Code:21635-1349
Practice Address - Country:US
Practice Address - Phone:410-648-5884
Practice Address - Fax:410-648-5764
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR132273163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult