Healthcare Provider Details

I. General information

NPI: 1285229625
Provider Name (Legal Business Name): ROSE MARY MARE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 09/29/2026
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 ROUTE 6 AND 209
MILFORD PA
18337-9454
US

IV. Provider business mailing address

10 BEACH RD
PORT JERVIS NY
12771-1307
US

V. Phone/Fax

Practice location:
  • Phone: 570-491-4121
  • Fax:
Mailing address:
  • Phone: 845-978-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number690175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: