Provider Demographics
NPI:1689276826
Name:WILSHIRE, ROSEMARY (MS)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:WILSHIRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GOOSE RUN LN
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1310
Mailing Address - Country:US
Mailing Address - Phone:304-203-1059
Mailing Address - Fax:
Practice Address - Street 1:104 GOOSE RUN LN
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1310
Practice Address - Country:US
Practice Address - Phone:304-203-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant