Provider Demographics
NPI:1477203842
Name:ROSOL, RUTH L
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:ROSOL
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 1:1078 TESTA DR
Mailing Address - Street 2:
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458-1273
Mailing Address - Country:US
Mailing Address - Phone:708-612-4804
Mailing Address - Fax:708-401-0153
Practice Address - Street 1:1078 TESTA DR
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-1273
Practice Address - Country:US
Practice Address - Phone:708-612-4804
Practice Address - Fax:708-401-0153
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor