Healthcare Provider Details

I. General information

NPI: 1144031295
Provider Name (Legal Business Name): MARLEE ANN ROSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5187
US

IV. Provider business mailing address

443 HICKORY LN
PLAINFIELD IN
46168-1836
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-8006
  • Fax:
Mailing address:
  • Phone: 317-800-0426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28276162A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: