Provider Demographics
NPI:1477700524
Name:ROSE, WINIFRED MAY (LPN)
Entity type:Individual
Prefix:MS
First Name:WINIFRED
Middle Name:MAY
Last Name:ROSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FORBUS ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2723
Mailing Address - Country:US
Mailing Address - Phone:845-473-3688
Mailing Address - Fax:845-473-6692
Practice Address - Street 1:110 FORBUS ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2723
Practice Address - Country:US
Practice Address - Phone:845-473-3688
Practice Address - Fax:845-473-6692
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291554-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse