Healthcare Provider Details

I. General information

NPI: 1184124455
Provider Name (Legal Business Name): KATHRYN ALVARADO-ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN ALVARADO

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 NW BEAVER ST STE 100
PRINEVILLE OR
97754-1802
US

IV. Provider business mailing address

19595 TOKATEE LAKE CT
BEND OR
97702-9157
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-5165
  • Fax:
Mailing address:
  • Phone: 775-762-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201341255RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: