Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 0101037041 | VA |
NPI | 1770500290 |
---|---|
Provider Name | Joan Helena Rose |
First Address | Virginia Beach, VA 23462-6543 |
Second Address | Virginia Beach, VA 23462-6543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 16/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007320221 | (05) | VA |