Provider Demographics
NPI:1912657925
Name:ROSE, TRANISE D'AUNDREA
Entity Type:Individual
Prefix:
First Name:TRANISE
Middle Name:D'AUNDREA
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 1:2704 N HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1026
Mailing Address - Country:US
Mailing Address - Phone:312-550-2551
Mailing Address - Fax:
Practice Address - Street 1:824 N MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3947
Practice Address - Country:US
Practice Address - Phone:312-550-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management