Provider Demographics
NPI:1902502586
Name:DEMENT ERTL, MARY ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:DEMENT ERTL
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:8542 BARLOW LN
Mailing Address - Street 2:
Mailing Address - City:LASCASSAS
Mailing Address - State:TN
Mailing Address - Zip Code:37085-4205
Mailing Address - Country:US
Mailing Address - Phone:330-749-2291
Mailing Address - Fax:
Practice Address - Street 1:1840 MEDICAL CENTER PKWY STE 400
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3237
Practice Address - Country:US
Practice Address - Phone:615-467-4644
Practice Address - Fax:615-467-4645
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-04-05
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Provider Licenses
StateLicense IDTaxonomies
TN33370363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health