Healthcare Provider Details

I. General information

NPI: 1548301203
Provider Name (Legal Business Name): JULIA C ROSE PA-C, ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

IV. Provider business mailing address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2663
  • Fax: 614-293-2053
Mailing address:
  • Phone: 614-293-2663
  • Fax: 614-293-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0624
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50003310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: