Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | NP 1692 | CO |
NPI | 1063716215 |
---|---|
Provider Name | Mary K Rousset |
First Address | Mancos, CO 81328-8748 |
Second Address | Cortez, CO 81321-9505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2011 |
Last Update Date | 03/01/2011 |