Provider Demographics
NPI:1083883300
Name:GARNER, ROSA MAE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ROSA
Middle Name:MAE
Last Name:GARNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 MANSION WAY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521
Mailing Address - Country:US
Mailing Address - Phone:434-846-0917
Mailing Address - Fax:
Practice Address - Street 1:454 MANSION WAY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521
Practice Address - Country:US
Practice Address - Phone:434-846-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002052173164W00000X
VA1046792OASA372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion