Provider Demographics
NPI:1609464197
Name:ROSE, SONJI (RN)
Entity Type:Individual
Prefix:
First Name:SONJI
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 ROSE RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:MS
Mailing Address - Zip Code:39332-3294
Mailing Address - Country:US
Mailing Address - Phone:601-917-9143
Mailing Address - Fax:601-635-2964
Practice Address - Street 1:541 ROSE RD
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:MS
Practice Address - Zip Code:39332-3294
Practice Address - Country:US
Practice Address - Phone:601-917-9143
Practice Address - Fax:601-635-2964
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS865996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty