Provider Demographics
NPI:1497914709
Name:OSTROWSKI, MARY ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:OSTROWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:508 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2953
Mailing Address - Country:US
Mailing Address - Phone:936-760-4600
Mailing Address - Fax:936-760-4601
Practice Address - Street 1:508 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2953
Practice Address - Country:US
Practice Address - Phone:936-760-4600
Practice Address - Fax:936-760-4601
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX638157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB114400Medicare PIN