Individual
HANNA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
975 W FARIS RD, GREENVILLE, SC 29605-4241
(864) 729-8330
Mailing address
975 W FARIS RD, GREENVILLE, SC 29605-4241
(864) 729-8330
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2510
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2669PA
—
SC
01
—
SC84368510
MEDICARE PIN
SC
01
—
SC84369068
MEDICARE PIN
SC
Enumeration date
06/29/2016
Last updated
01/20/2023
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