| Doctor Name: | MARY K ROUSSET |
| NPI Number: | 1063716215 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | NP 1692 |
| Business Practice Address: | 1345 S Broadway Cortez, CO - 813219505 |
| Business Phone Number: | 9705654400 |
| Business Fax Number: | 9705659543 |
| Mailing Address: | 36665 Road P.3, MANCOS |
| State: | CO |
| Postal Code: | 813288748 |
| Phone Number: | 9708824750 |
| Fax Number: | |
| NPI Enumeration Date: | 01/03/2011 |
| NPI Last Update Date: | 01/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | NP 1692 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |