Provider Demographics
NPI:1831146935
Name:ROUSE, MARY EVELYN (APRN, PMH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EVELYN
Last Name:ROUSE
Suffix:
Gender:F
Credentials:APRN, PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 SHADY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1301
Mailing Address - Country:US
Mailing Address - Phone:301-330-0400
Mailing Address - Fax:301-948-4333
Practice Address - Street 1:9055 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:301-330-0400
Practice Address - Fax:301-948-4333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR043705163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD311421OtherUNITED HEALTHCARE-MAMSI
S51973Medicare UPIN
000B31M32Medicare ID - Type Unspecified