Provider Demographics
NPI:1174166086
Name:ROSE, A. DANIELL (RN)
Entity type:Individual
Prefix:PROF
First Name:A.
Middle Name:DANIELL
Last Name:ROSE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN, MPA
Mailing Address - Street 1:400 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3512
Mailing Address - Country:US
Mailing Address - Phone:334-747-8127
Mailing Address - Fax:
Practice Address - Street 1:400 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3512
Practice Address - Country:US
Practice Address - Phone:334-747-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125180163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse