Provider Demographics
NPI:1548868532
Name:ROSE, MILDRED ELAINE
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:ELAINE
Last Name:ROSE
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 1:8043 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:KIMBOLTON
Mailing Address - State:OH
Mailing Address - Zip Code:43749-9736
Mailing Address - Country:US
Mailing Address - Phone:330-605-7458
Mailing Address - Fax:
Practice Address - Street 1:8043 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:KIMBOLTON
Practice Address - State:OH
Practice Address - Zip Code:43749-9736
Practice Address - Country:US
Practice Address - Phone:740-432-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver