Provider Demographics
NPI:1831664267
Name:DELAROSA, ERNESTINE
Entity Type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:
Last Name:DELAROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:DELAROSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:491 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4080
Mailing Address - Country:US
Mailing Address - Phone:616-403-8790
Mailing Address - Fax:
Practice Address - Street 1:1101 BALL AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5904
Practice Address - Country:US
Practice Address - Phone:616-456-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist