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General NPI Number Information
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NPI Number | 1790155273
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Entity Type | Individual
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Provider Name | LESLIE LEE ROSE PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2015
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 2462 E HILL RD STE 1
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City | GRAND BLANC
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State | MI
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Zip | 48439-5427
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Country | US
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Telephone | 810-695-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 3495 S CENTER RD
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City | BURTON
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State | MI
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Zip | 48519-1455
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601007493
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License Number State | MI
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