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NPI Code Detail

MEDICARE: MS. VALLERIE ANNESTHER ROSE RN

MEDICARE: MS. VALLERIE ANNESTHER ROSE RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN0000061224TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14253OTHERTNPROVIDER ID

General Provider Information

NPI Number : 1275664070
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VALLERIE ANNESTHER ROSE RN
Provider Business Mailing Address
First Line : 202 TWERP TRL
Second Line :
City : ESTILL SPRINGS
State : TN
Zip : 37330-3733
Country : US
Telephone Number : 931-649-2214
Fax Number :
Provider Business Practice Location Address
First Line : 615 WILSON AVE # L
Second Line :
City : TULLAHOMA
State : TN
Zip : 37388-3264
Country : US
Telephone Number : 931-455-9369
Fax Number : 931-455-4827
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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