Provider Demographics
NPI:1538365655
Name:ROSE, NADINE TERRAZAS (MD)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:TERRAZAS
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:TERRAZAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:
Practice Address - Street 1:205 E FREY ST UNIT 101
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-2609
Practice Address - Country:US
Practice Address - Phone:254-918-2484
Practice Address - Fax:254-965-3294
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25673208000000X
TXP0125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics