Healthcare Provider Details

I. General information

NPI: 1992123053
Provider Name (Legal Business Name): ROSA MENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN ST
MCPHERSON KS
67460-4308
US

IV. Provider business mailing address

320 N MAIN ST
MCPHERSON KS
67460-4308
US

V. Phone/Fax

Practice location:
  • Phone: 620-504-6313
  • Fax: 620-504-6315
Mailing address:
  • Phone: 620-504-6313
  • Fax: 620-504-6315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1329
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: