Provider Demographics
NPI:1598283830
Name:ROSE, MARY FRANCES (LNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRANCES
Last Name:ROSE
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 BERLIN RD APT K
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1956
Mailing Address - Country:US
Mailing Address - Phone:419-677-9834
Mailing Address - Fax:
Practice Address - Street 1:41641 N RIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1264
Practice Address - Country:US
Practice Address - Phone:440-324-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHLPN.165630.MEDS-IV164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)