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General NPI Number Information
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NPI Number | 1497224307
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Entity Type | Individual
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Provider Name | ROSE NDUA LICENSED NURSE
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Gender | Female
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 10344 14TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98168-1689
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Country | US
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Telephone | 206-245-1086
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Fax |
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Provider Business Mailing Address
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Address Line | 11404 105TH AVE SW APT B7
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City | LAKEWOOD
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State | WA
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Zip | 98498-6834
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Country | US
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Telephone | 253-844-5750
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LP60645770
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License Number State | WA
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