Basic Information
| Provider Information | |||||||||
| NPI: | 1780830430 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRANDT | ||||||||
| OtherFirstName: | ROSE | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11059 E BETHANY DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172300 | ||||||||
| FaxNumber: | 3036172397 | ||||||||
| Practice Location | |||||||||
| Address1: | 11059 E BETHANY DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172300 | ||||||||
| FaxNumber: | 3036172397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.