Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 29579 | WI |
NPI | 1225130834 |
---|---|
Provider Name | Dr. Nirmala Jasti Rozario |
First Address | Montgomery, AL 36116-6638 |
Second Address | Tuskegee, AL 36083-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 13/07/2007 |