Individual
BLAIR NICOLE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1717 MAIN ST, 5200, DALLAS, TX 75201-4612
(214) 712-2444
Mailing address
804 ANDERSONVILLE LN, WYLIE, TX 75098-5304
(972) 742-6091
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
TX
Other
Enumeration date
12/22/2010
Last updated
12/22/2010
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