Provider Demographics
NPI:1235274416
Name:ROSE, MARILYN K (LMP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:K
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMP
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Mailing Address - Street 1:3627 WHEATON WAY
Mailing Address - Street 2:SUITE105A
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3545
Mailing Address - Country:US
Mailing Address - Phone:360-377-3601
Mailing Address - Fax:360-373-9494
Practice Address - Street 1:3627 WHEATON WAY
Practice Address - Street 2:SUITE105A
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3545
Practice Address - Country:US
Practice Address - Phone:360-377-3601
Practice Address - Fax:360-373-9494
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA0004969225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARO7426OtherREGENCE
WA0155410OtherDEPARTMENT OF LABOR & IND
WA91211509101OtherKITSAP PHYSICIANS SERVICE