Individual
BEVERLY A DE LA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4005 FAYETTEVILLE RD, RAEFORD, NC 28376-8058
(910) 848-5437
Mailing address
4005 FAYETTEVILLE RD, RAEFORD, NC 28376-8058
(910) 848-5437
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
5018560
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
06/27/2023
Last updated
12/09/2024
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