Provider Demographics
NPI:1437485901
Name:ROSE, MICHIKO DANILLIE
Entity Type:Individual
Prefix:
First Name:MICHIKO
Middle Name:DANILLIE
Last Name:ROSE
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 1:1120 WHETSTONE ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-3352
Mailing Address - Country:US
Mailing Address - Phone:419-709-2400
Mailing Address - Fax:
Practice Address - Street 1:3928 HORIZON DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44903-6541
Practice Address - Country:US
Practice Address - Phone:419-709-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123747MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse