Provider Demographics
NPI:1528293685
Name:ROSE, FARRAH LEE
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:LEE
Last Name:ROSE
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 1:135 WALTER DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7411
Mailing Address - Country:US
Mailing Address - Phone:570-523-5023
Mailing Address - Fax:570-523-5003
Practice Address - Street 1:135 WALTER DR STE 2
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7411
Practice Address - Country:US
Practice Address - Phone:570-523-5023
Practice Address - Fax:570-523-5003
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03176237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF03176OtherFITTER OF HEARING AIDS