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General NPI Number Information
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NPI Number | 1245848894
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Entity Type | Individual
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Provider Name | MYESHIA ROSE
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Gender | Female
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 3250 HOLLAND DR
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City | PETERSBURG
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State | VA
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Zip | 23805-9664
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Country | US
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Telephone | 434-294-3807
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 HOLLAND DR
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City | PETERSBURG
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State | VA
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Zip | 23805-9664
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Country | US
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Telephone |
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Fax |
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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