MEDICARE: SAMISHA ROSE

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
1	390200000X	Student in an Organized Health Care Education/Training Program	390200000X	NC

General Provider Information

NPI Number	:	1962271254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMISHA ROSE

Provider Business Mailing Address
First Line	:	106 W CALHOUN ST
Second Line	:
City	:	DILLON
State	:	SC
Zip	:	29536-4014
Country	:	US
Telephone Number	:	843-627-3121
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 W CALHOUN ST
Second Line	:
City	:	DILLON
State	:	SC
Zip	:	29536-4014
Country	:	US
Telephone Number	:	843-627-3121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	01/06/2024

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Directions to “ SAMISHA ROSE ” Practice Location

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