Provider Demographics
NPI:1891920278
Name:YARRISH, MARY ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:YARRISH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S MAIN ST
Mailing Address - Street 2:ROOM 1500
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4802
Mailing Address - Country:US
Mailing Address - Phone:817-321-4850
Mailing Address - Fax:817-321-4809
Practice Address - Street 1:1101 S MAIN ST
Practice Address - Street 2:ROOM 1500
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4802
Practice Address - Country:US
Practice Address - Phone:817-321-4850
Practice Address - Fax:817-321-4809
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX411941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse