Provider Demographics
NPI:1336842889
Name:THADISON, LORETTA (RN)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:THADISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:3719 ACACIA WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7681
Mailing Address - Country:US
Mailing Address - Phone:346-629-9257
Mailing Address - Fax:
Practice Address - Street 1:3719 ACACIA WOOD WAY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7681
Practice Address - Country:US
Practice Address - Phone:346-629-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159263005251E00000X
TX251J00000X, 385H00000X, 374U00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care