Provider Demographics
NPI:1881573350
Name:ROSE, LESHA D
Entity type:Individual
Prefix:
First Name:LESHA
Middle Name:D
Last Name:ROSE
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 1:642 W RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-2644
Mailing Address - Country:US
Mailing Address - Phone:810-293-3323
Mailing Address - Fax:
Practice Address - Street 1:642 W RUTH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-2644
Practice Address - Country:US
Practice Address - Phone:810-293-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker