Provider Demographics
NPI:1255584124
Name:ROSE, MARGARITA (LICENSE PRACTICAL NU)
Entity type:Individual
Prefix:MISS
First Name:MARGARITA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LICENSE PRACTICAL NU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-0556
Mailing Address - Country:US
Mailing Address - Phone:845-633-1947
Mailing Address - Fax:
Practice Address - Street 1:55 LEGGS MILLS RD
Practice Address - Street 2:
Practice Address - City:LAKE KATINE
Practice Address - State:NY
Practice Address - Zip Code:12449
Practice Address - Country:US
Practice Address - Phone:845-633-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276409-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse