Individual
ROSE MARIE IDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
217 E ANTIETAM ST, HAGERSTOWN, MD 21740-5724
(240) 420-0000
Mailing address
217 E ANTIETAM ST, HAGERSTOWN, MD 21740-5724
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
12488
WV
Other
Enumeration date
03/30/2021
Last updated
03/30/2021
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