Provider Demographics
NPI:1932781341
Name:MOTHERSIL, MARIE MITCHELLE (CNA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MITCHELLE
Last Name:MOTHERSIL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6188
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33466-6188
Mailing Address - Country:US
Mailing Address - Phone:561-729-7346
Mailing Address - Fax:
Practice Address - Street 1:2425 2ND AVE N APT 75
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-0920
Practice Address - Country:US
Practice Address - Phone:561-908-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion