Healthcare Provider Details

I. General information

NPI: 1710239173
Provider Name (Legal Business Name): LAURA JILL ROSE MSN APRN ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26900 CEDAR RD FAMILY MEDICINE
BEACHWOOD OH
44122-1191
US

IV. Provider business mailing address

26900 CEDAR RD FAMILY MEDICINE
BEACHWOOD OH
44122-1191
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-3000
  • Fax:
Mailing address:
  • Phone: 216-839-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.318361-COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.13481-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRX.13481-EX1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: