Healthcare Provider Details

I. General information

NPI: 1578167318
Provider Name (Legal Business Name): ROSA ROSE POND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

9814 PARTHENON CT APT E
CHARLOTTE NC
28262-0274
US

V. Phone/Fax

Practice location:
  • Phone: 208-440-8175
  • Fax:
Mailing address:
  • Phone: 208-440-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP61126919
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number310363
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: