# MS. ROXANNE MAE ROSE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1124084942
- **Gender:** F
- **Credential:** PHD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 2096 | ND | Yes |

## Other

- **Enumeration date:** 04/21/2006
- **Last updated:** 02/02/2012

## 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 |