Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 211251 | NC |
NPI | 1932605383 |
---|---|
Provider Name | Dr. Mara Frances Rose |
First Address | Wilmington, NC 28411-9411 |
Second Address | Wilmington, NC 28405-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 04/04/2018 |