Healthcare Provider Details

I. General information

NPI: 1134941685
Provider Name (Legal Business Name): MISHELLE LA ROSE CMA, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-3952
  • Fax: 240-595-6728
Mailing address:
  • Phone: 240-413-3952
  • Fax: 240-595-6728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number01
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: