Healthcare Provider Details

I. General information

NPI: 1275502288
Provider Name (Legal Business Name): ROSE A WARHANK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSE A MILLANE MD

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 11TH ST
DE WITT IA
52742-1210
US

IV. Provider business mailing address

4210 FOREST RD
DAVENPORT IA
52807-1540
US

V. Phone/Fax

Practice location:
  • Phone: 563-659-9137
  • Fax: 563-659-9869
Mailing address:
  • Phone: 563-659-9137
  • Fax: 563-659-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28338
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: