Provider Demographics
NPI:1154774131
Name:OWUSU, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:OWUSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 HEATHWICK CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3259
Mailing Address - Country:US
Mailing Address - Phone:703-657-9647
Mailing Address - Fax:
Practice Address - Street 1:6036 HEATHWICK CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3259
Practice Address - Country:US
Practice Address - Phone:703-657-9647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002074282164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse