Provider Demographics
NPI:1659821346
Name:ROSE, DEBRA (LAC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1047
Mailing Address - Country:US
Mailing Address - Phone:302-519-3029
Mailing Address - Fax:
Practice Address - Street 1:506 UNION ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1047
Practice Address - Country:US
Practice Address - Phone:302-519-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist