Healthcare Provider Details

I. General information

NPI: 1831183326
Provider Name (Legal Business Name): WARREN THOMAS ROSELAND JR. MSN, RN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOM ROSELAND MSN, RN, FNP-C

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 NW STEWART PKWY STE 200
ROSEBURG OR
97471-1650
US

IV. Provider business mailing address

4803 ELKRIDGE RD
WEED CA
96094-9424
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-4285
  • Fax:
Mailing address:
  • Phone: 209-769-6112
  • Fax: 209-720-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN 409980
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201811353
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP9245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: