Provider Demographics
NPI:1811869498
Name:ROSS, MARY L (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:317 JAKES TRL NW
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-8632
Mailing Address - Country:US
Mailing Address - Phone:601-265-2018
Mailing Address - Fax:949-864-3748
Practice Address - Street 1:317 JAKES TRL NW
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-8632
Practice Address - Country:US
Practice Address - Phone:601-265-2018
Practice Address - Fax:949-864-3748
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR861890163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator