Healthcare Provider Details

I. General information

NPI: 1356747356
Provider Name (Legal Business Name): BECKY C ROSE AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E PERSHING BLVD
CHEYENNE WY
82001-5356
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE SUITE 300
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-7558
  • Fax: 307-778-7328
Mailing address:
  • Phone: 970-619-6100
  • Fax: 970-619-6190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0204118
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0991538-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0991538-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: