Individual
MRS. MARY JANE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN
Contact information
Practice address
2215 FULLER RD, ANN ARBOR, MI 48105-2335
(734) 769-7100
Mailing address
6420 SCULLY RD, DEXTER, MI 48130-9303
(734) 769-7100
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4704098180
MI
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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