Provider Demographics
NPI:1598360877
Name:ROSE, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:ROSE
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 1:602 FROZEN CAMP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25244-8900
Mailing Address - Country:US
Mailing Address - Phone:304-514-0283
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:1222 MARKET ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4323
Practice Address - Country:US
Practice Address - Phone:304-485-5420
Practice Address - Fax:304-485-5423
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker