Healthcare Provider Details

I. General information

NPI: 1942445101
Provider Name (Legal Business Name): ROSE ROWAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

1703 ESCALANTE AVE SW
ALBUQUERQUE NM
87104-1010
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-4065
  • Fax:
Mailing address:
  • Phone: 505-243-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR29941
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: