Provider Demographics
NPI:1912410614
Name:HIMEBAUGH, ROSE MARY
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARY
Last Name:HIMEBAUGH
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 1:5360 SECOR RD APT 216
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2427
Mailing Address - Country:US
Mailing Address - Phone:419-481-2936
Mailing Address - Fax:
Practice Address - Street 1:5360 SECOR RD APT 216
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2427
Practice Address - Country:US
Practice Address - Phone:419-481-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care