Individual
MARY ROSE BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
22 TOPEKA CT, TINTON FALLS, NJ 07712-7508
(732) 618-7718
Mailing address
22 TOPEKA CT, TINTON FALLS, NJ 07712-7508
(732) 618-7718
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
26NJ00851300
NJ
363LG0600X
Gerontology Nurse Practitioner
Primary
26NJ00851300
NJ
Other
Enumeration date
08/30/2018
Last updated
04/21/2026
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