Healthcare Provider Details

I. General information

NPI: 1053121350
Provider Name (Legal Business Name): CORA J ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W NEPESSING ST STE 300
LAPEER MI
48446-2089
US

IV. Provider business mailing address

624 W NEPESSING ST STE 300
LAPEER MI
48446-2089
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: