Provider Demographics
NPI:1609086610
Name:MABREY, ROSE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:MABREY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4791 GERALDINE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2831
Mailing Address - Country:US
Mailing Address - Phone:216-297-0793
Mailing Address - Fax:216-297-0793
Practice Address - Street 1:4791 GERALDINE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2831
Practice Address - Country:US
Practice Address - Phone:216-297-0793
Practice Address - Fax:216-297-0793
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-09340164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse