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Individual

MS. ROXANNE MAE ROSE

Active
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Individual

MS. ROXANNE MAE ROSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2096
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181620900
—
MN
05
—
19124
—
ND
01
—
23117
BC/BC
ND
01
—
24043
ND BC/BS
ND
01
—
284K8DA
MN BC/BS
MN
01
—
N715569
MEDICARE PTAN
ND
Enumeration date
04/21/2006
Last updated
02/02/2012
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