Provider Demographics
NPI:1417541970
Name:NEWBERRY, ROSE ALIENE (CO)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ALIENE
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 13TH AVE W APT 306
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2054
Mailing Address - Country:US
Mailing Address - Phone:503-724-0359
Mailing Address - Fax:
Practice Address - Street 1:616 120TH AVE NE STE C111
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3048
Practice Address - Country:US
Practice Address - Phone:425-450-1598
Practice Address - Fax:425-450-1598
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist