Provider Demographics
NPI:1407324320
Name:GARRIOTT, ROSESHEL ANNE (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ROSESHEL
Middle Name:ANNE
Last Name:GARRIOTT
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:DR
Other - First Name:ROSESHEL
Other - Middle Name:ANNE
Other - Last Name:GARRIOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DACM, LAC
Mailing Address - Street 1:1830 N LAKES PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1921
Mailing Address - Country:US
Mailing Address - Phone:208-614-1640
Mailing Address - Fax:
Practice Address - Street 1:1830 N LAKES PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1921
Practice Address - Country:US
Practice Address - Phone:208-614-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist