Provider Demographics
NPI:1972371599
Name:GARRISON, ROSALEE
Entity type:Individual
Prefix:
First Name:ROSALEE
Middle Name:
Last Name:GARRISON
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 1:366 STAR BRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WV
Mailing Address - Zip Code:26404
Mailing Address - Country:US
Mailing Address - Phone:304-496-8150
Mailing Address - Fax:
Practice Address - Street 1:366 STAR BRIGHT DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WV
Practice Address - Zip Code:26404
Practice Address - Country:US
Practice Address - Phone:304-496-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker