Individual
TIFFANI ALISE ROUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 ARGYLE ST, REVERE, MA 02151-4805
(857) 312-6950
Mailing address
17 ARGYLE ST, REVERE, MA 02151-4805
(857) 312-6950
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN87546
MA
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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