| Doctor Name: | MARY ROSS |
| NPI Number: | 1124402698 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 0000095307 |
| Business Practice Address: | 10825 Old Highway 64 Bolivar, TN - 380083599 |
| Business Phone Number: | 7316585291 |
| Business Fax Number: | 7316586536 |
| Mailing Address: | 10825 Old Highway 64, Po Box 670 BOLIVAR |
| State: | TN |
| Postal Code: | 380083599 |
| Phone Number: | 7316585291 |
| Fax Number: | 7316586536 |
| NPI Enumeration Date: | 07/15/2015 |
| NPI Last Update Date: | 07/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 0000095307 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |