Individual
MS. KRISTINA MARIE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
104 E D ST STE 2, SHELTON, WA 98584-2122
(360) 462-2639
Mailing address
PO BOX 1004, SHELTON, WA 98584-1004
(360) 462-2639
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA22099
WA
Other
Enumeration date
07/30/2007
Last updated
07/30/2007
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