Provider Demographics
NPI:1821129776
Name:ROSALIA HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:ROSALIA HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-523-4950
Mailing Address - Street 1:703 S WHITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSALIA
Mailing Address - State:WA
Mailing Address - Zip Code:99170
Mailing Address - Country:US
Mailing Address - Phone:509-523-4950
Mailing Address - Fax:509-523-4951
Practice Address - Street 1:703 S WHITMAN AVE
Practice Address - Street 2:
Practice Address - City:ROSALIA
Practice Address - State:WA
Practice Address - Zip Code:99170
Practice Address - Country:US
Practice Address - Phone:509-523-4950
Practice Address - Fax:509-523-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004008363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty