Provider Demographics
NPI:1174901243
Name:ROSELL, VERA ANN
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:ANN
Last Name:ROSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 WOODBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5810
Mailing Address - Country:US
Mailing Address - Phone:678-951-6281
Mailing Address - Fax:
Practice Address - Street 1:3595 WOODBRIAR CIR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5810
Practice Address - Country:US
Practice Address - Phone:678-951-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA27-2425322OtherNONE