Provider Demographics
NPI:1841687175
Name:THERUVATH, PRINCY P (RN)
Entity type:Individual
Prefix:MRS
First Name:PRINCY
Middle Name:P
Last Name:THERUVATH
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 1:2751 KENEDY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0735
Mailing Address - Country:US
Mailing Address - Phone:530-339-0074
Mailing Address - Fax:
Practice Address - Street 1:2751 KENEDY LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-0735
Practice Address - Country:US
Practice Address - Phone:530-339-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX766170163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical