Provider Demographics
NPI:1457461592
Name:HOOD, ROSA LANE (BSN RN)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:LANE
Last Name:HOOD
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:JOHNSTON COUNTY MENTAL HEALTH CENTER
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0411
Mailing Address - Country:US
Mailing Address - Phone:919-989-5500
Mailing Address - Fax:919-989-5532
Practice Address - Street 1:521 N BRIGHTLEAF BLVD
Practice Address - Street 2:JOHNSTON COUNTY MENTAL HEALTH CENTER
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-989-5500
Practice Address - Fax:919-989-5532
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-20
Deactivation Date:2007-02-09
Deactivation Code:
Reactivation Date:2007-10-03
Provider Licenses
StateLicense IDTaxonomies
NC063890163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherTRICARE