Healthcare Provider Details

I. General information

NPI: 1548506397
Provider Name (Legal Business Name): MARY ANN RHODES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 LONG LAKE DR APT 2214
BATAVIA OH
45103
US

IV. Provider business mailing address

4352 LONG LAKE DR APT 2214
BATAVIA OH
45103
US

V. Phone/Fax

Practice location:
  • Phone: 707-458-9027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN135300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: