Doctor Name: | MELISSA ROSAS |
NPI Number: | 1568786481 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | 79956 |
Business Practice Address: | 29501 Kickapoo Rd Mcloud, OK - 748518320 |
Business Phone Number: | 4059643020 |
Business Fax Number: | 4059643014 |
Mailing Address: | 29501 Kickapoo Rd, MCLOUD |
State: | OK |
Postal Code: | 748518320 |
Phone Number: | 4059643020 |
Fax Number: | 4059643014 |
NPI Enumeration Date: | 03/22/2010 |
NPI Last Update Date: | 10/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 79956 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |