Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 8853 | TN |
Y | 1223P0106X | Oral and Maxillofacial Pathology | P-143 | LA |
NPI | 1992835060 |
---|---|
Provider Name | Dr. Molly Susan Rosebush |
First Address | New Orleans, LA 70119-2714 |
Second Address | New Orleans, LA 70119-2714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 27/06/2013 |