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General NPI Number Information
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NPI Number | 1134941685
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Entity Type | Individual
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Provider Name | MISHELLE LA ROSE CMA, CPT
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 5000 THAYER CTR STE C
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City | OAKLAND
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State | MD
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Zip | 21550-1139
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Country | US
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Telephone | 240-413-3952
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Fax | 240-595-6728
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Provider Business Mailing Address
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Address Line | 5000 THAYER CTR STE C
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City | OAKLAND
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State | MD
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Zip | 21550-1139
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Country | US
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Telephone | 240-413-3952
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Fax | 240-595-6728
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 01
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License Number State | MD
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