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Individual

DONNA ROSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
8128 N IVORY ROSE DR, TUCSON, AZ 85741-4050
(520) 572-3908
Mailing address
8128 N IVORY ROSE DR, TUCSON, AZ 85741-4050
(520) 572-3908

Taxonomy

Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
8419
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8419
OLCR LICENSE
AZ
Enumeration date
02/21/2013
Last updated
02/21/2013
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