Individual
SHAUN DONOVAN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 FARRAGUT AVE, COLORADO SPRINGS, CO 80909-5626
(912) 414-9652
Mailing address
1510 CHILES AVE # 7-335, FORT CARSON, CO 80913-4109
(912) 414-9652
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17-091-3996
DRIVERS LICENSE
CO
Enumeration date
07/11/2022
Last updated
07/11/2022
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