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General NPI Number Information
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NPI Number | 1669104824
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Entity Type | Individual
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Provider Name | NYLEJA ROSE
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 2910 S GLEBE RD APT 224
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City | ARLINGTON
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State | VA
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Zip | 22206-2745
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Country | US
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Telephone | 302-287-5028
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 S GLEBE RD APT 224
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City | ARLINGTON
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State | VA
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Zip | 22206-2745
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Country | US
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Telephone | 302-287-5028
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-222522
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License Number State | VA
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