Provider Demographics
NPI:1265832984
Name:VERRETT, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:VERRETT
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 1:2868 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2252
Mailing Address - Country:US
Mailing Address - Phone:937-414-2219
Mailing Address - Fax:
Practice Address - Street 1:2868 VALLEYVIEW DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2252
Practice Address - Country:US
Practice Address - Phone:937-414-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2742385374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide