Provider Demographics
NPI:1578223327
Name:CREECY, ROSE MARIE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:CREECY
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 1:2401 YORKTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2321
Mailing Address - Country:US
Mailing Address - Phone:504-202-5384
Mailing Address - Fax:
Practice Address - Street 1:2401 YORKTOWNE DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2321
Practice Address - Country:US
Practice Address - Phone:504-202-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007528367172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver