Healthcare Provider Details

I. General information

NPI: 1366832677
Provider Name (Legal Business Name): DAWNA ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 ANN ST
PARKERSBURG WV
26101-5122
US

IV. Provider business mailing address

2507 9TH AVE
PARKERSBURG WV
26101-5855
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-5065
  • Fax:
Mailing address:
  • Phone: 304-485-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61571
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN61571FNP-BC
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN61571
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: