Provider Demographics
NPI:1437488228
Name:MILLER, ROSE A
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:A
Other - Last Name:ETUBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HCS, TXHML
Mailing Address - Street 1:7312 LAURIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112
Mailing Address - Country:US
Mailing Address - Phone:817-429-0654
Mailing Address - Fax:817-429-0654
Practice Address - Street 1:7312 LAURIE DRIVE
Practice Address - Street 2:
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112
Practice Address - Country:US
Practice Address - Phone:817-806-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator