Healthcare Provider Details

I. General information

NPI: 1225550270
Provider Name (Legal Business Name): ROSE M BAZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 GRAND AVE
CINCINNATI OH
45214-1502
US

IV. Provider business mailing address

2894 ZIEGLE AVE # 2
CINCINNATI OH
45208-1535
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-4600
  • Fax:
Mailing address:
  • Phone: 206-369-9474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN410086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: