Healthcare Provider Details

I. General information

NPI: 1881663185
Provider Name (Legal Business Name): ANDREW N ROSE PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 WHIPPLE AVE # 30
LOGANDALE NV
89021
US

IV. Provider business mailing address

1925 WHIPPLE AVE # 30
LOGANDALE NV
89021-9934
US

V. Phone/Fax

Practice location:
  • Phone: 702-398-3621
  • Fax: 23-983-6267
Mailing address:
  • Phone: 702-398-3621
  • Fax: 702-398-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1560
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: