Healthcare Provider Details

I. General information

NPI: 1083969158
Provider Name (Legal Business Name): AMBER JOYE ROSEN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 STERRETT PL SUITE 100
COLUMBIA MD
21044-2611
US

IV. Provider business mailing address

1001 E. SUNSET ROAD UNIT 96595
LAS VEGAS NV
89193-1246
US

V. Phone/Fax

Practice location:
  • Phone: 443-218-4004
  • Fax:
Mailing address:
  • Phone: 702-798-0113
  • Fax: 866-291-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01259
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: