Provider Demographics
NPI:1093197865
Name:ROSO, DEBBIE LEA (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:LEA
Last Name:ROSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:DEBBIE
Other - Middle Name:LEA
Other - Last Name:ROSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1631 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3585
Mailing Address - Country:US
Mailing Address - Phone:817-865-5300
Mailing Address - Fax:
Practice Address - Street 1:1631 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3585
Practice Address - Country:US
Practice Address - Phone:817-865-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534124363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health