Healthcare Provider Details

I. General information

NPI: 1376625582
Provider Name (Legal Business Name): HEIDI ALAHN ROSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI ALAHN WHITNEY BSN

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 RIVER PARK DR STE 200
SACRAMENTO CA
95815-4517
US

IV. Provider business mailing address

1495 RIVER PARK DR STE 200
SACRAMENTO CA
95815-4517
US

V. Phone/Fax

Practice location:
  • Phone: 916-925-7020
  • Fax:
Mailing address:
  • Phone: 916-925-7020
  • Fax: 916-925-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number557389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95003885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: