Provider Demographics
NPI:1326445271
Name:ROSSER, LOLITA
Entity Type:Individual
Prefix:
First Name:LOLITA
Middle Name:
Last Name:ROSSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 COUNTRY VILLAGE DR STE 101-B
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2029
Mailing Address - Country:US
Mailing Address - Phone:901-310-4619
Mailing Address - Fax:901-405-5746
Practice Address - Street 1:8150 COUNTRY VILLAGE DR STE 101-B
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2029
Practice Address - Country:US
Practice Address - Phone:901-310-4619
Practice Address - Fax:901-405-5746
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000013232171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor