Healthcare Provider Details

I. General information

NPI: 1831146935
Provider Name (Legal Business Name): MARY EVELYN ROUSE APRN, PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

9055 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-0400
  • Fax: 301-948-4333
Mailing address:
  • Phone: 301-330-0400
  • Fax: 301-948-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR043705
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: