Provider Demographics
NPI:1902303365
Name:WILLIE, ROSA FINLEY
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:FINLEY
Last Name:WILLIE
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 1:1514 LAKE SPEIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6004
Mailing Address - Country:US
Mailing Address - Phone:757-934-2117
Mailing Address - Fax:757-934-2117
Practice Address - Street 1:1514 LAKE SPEIGHT DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6004
Practice Address - Country:US
Practice Address - Phone:757-934-2117
Practice Address - Fax:757-934-2117
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide