Provider Demographics
NPI:1295470870
Name:ROSE, GWENDOLYN A (DO)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:A
Last Name:ROSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 SHENANDOAH RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1673
Mailing Address - Country:US
Mailing Address - Phone:419-901-3879
Mailing Address - Fax:
Practice Address - Street 1:1906 SHENANDOAH RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-1673
Practice Address - Country:US
Practice Address - Phone:419-901-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care