Provider Demographics
NPI:1649456245
Name:LAMOTHE, MARY (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:LAMOTHE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:451 MANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4035
Mailing Address - Country:US
Mailing Address - Phone:772-388-4023
Mailing Address - Fax:
Practice Address - Street 1:451 MANGO AVE
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4035
Practice Address - Country:US
Practice Address - Phone:772-388-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5152383164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse