Basic Information
| Provider Information | |||||||||
| NPI: | 1306335211 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROCCO | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | JANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 ABIGAIL LN | ||||||||
| Address2: | |||||||||
| City: | PORT MATILDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168707153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142727713 | ||||||||
| FaxNumber: | 8142726507 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 ABIGAIL LN | ||||||||
| Address2: | |||||||||
| City: | PORT MATILDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168707153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142727713 | ||||||||
| FaxNumber: | 8142726507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2018 | ||||||||
| LastUpdateDate: | 05/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | RN267505L | PA | Y | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory |
No ID Information.