Individual
MICKEETA LASHOONE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
717 NE 79TH PL, OKLAHOMA CITY, OK 73114-4106
(405) 505-3598
Mailing address
1200 NE 13TH ST, OKLAHOMA CITY, OK 73117-1022
(405) 248-9368
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/16/2017
Last updated
12/16/2017
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