Provider Demographics
NPI:1316429442
Name:MANSUR, JANE LOUISE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
Last Name:MANSUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BIRDBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5191
Mailing Address - Country:US
Mailing Address - Phone:214-799-5807
Mailing Address - Fax:
Practice Address - Street 1:225 BIRDBROOK DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5191
Practice Address - Country:US
Practice Address - Phone:214-799-5807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX726197163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse