| Doctor Name: | ROSE M ROTH-BOWERSOCK |
| NPI Number: | 1417937020 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PNP-BC |
| License Number: | 470420936 |
| Business Practice Address: | 451 Health Pkwy Suite E Paw Paw, MI - 490798242 |
| Business Phone Number: | 2696553090 |
| Business Fax Number: | 2696550763 |
| Mailing Address: | 451 Health Pkwy, Suite E PAW PAW |
| State: | MI |
| Postal Code: | 490798242 |
| Phone Number: | 2696553090 |
| Fax Number: | 2696550763 |
| NPI Enumeration Date: | 01/19/2006 |
| NPI Last Update Date: | 10/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 470420936 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |