Provider Demographics
NPI:1902247687
Name:TUBBS, ROSE M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:M
Last Name:TUBBS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9946 CARLISLE RD N
Mailing Address - Street 2:
Mailing Address - City:TABERG
Mailing Address - State:NY
Mailing Address - Zip Code:13471-2008
Mailing Address - Country:US
Mailing Address - Phone:315-338-3789
Mailing Address - Fax:
Practice Address - Street 1:9946 CARLISLE RD N
Practice Address - Street 2:
Practice Address - City:TABERG
Practice Address - State:NY
Practice Address - Zip Code:13471-2008
Practice Address - Country:US
Practice Address - Phone:315-338-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248762164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse