Healthcare Provider Details

I. General information

NPI: 1821071150
Provider Name (Legal Business Name): MARY CARR ROSS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 S STOUGHTON RD
MADISON WI
53716-2257
US

IV. Provider business mailing address

1821 S STOUGHTON RD
MADISON WI
53716-2257
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-6000
  • Fax: 608-260-6835
Mailing address:
  • Phone: 608-260-6000
  • Fax: 608-260-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number24-033
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: