Provider Demographics
NPI:1851987135
Name:ROSE, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 FREELAND CROSSCUT RD
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-7344
Mailing Address - Country:US
Mailing Address - Phone:304-290-2990
Mailing Address - Fax:
Practice Address - Street 1:704 FREELAND CROSSCUT RD
Practice Address - Street 2:
Practice Address - City:TERRA ALTA
Practice Address - State:WV
Practice Address - Zip Code:26764-7344
Practice Address - Country:US
Practice Address - Phone:304-290-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide