Individual
ELAINE RENEE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
12345 HEATHER ST NW, COON RAPIDS, MN 55433-1754
(612) 963-1301
Mailing address
12345 HEATHER ST NW, COON RAPIDS, MN 55433-1754
(612) 963-1301
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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