Healthcare Provider Details

I. General information

NPI: 1477244358
Provider Name (Legal Business Name): GENNY ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 W C ST
TORRINGTON WY
82240-1834
US

IV. Provider business mailing address

1312 E 23RD ST
CHEYENNE WY
82001-4008
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-0134
  • Fax:
Mailing address:
  • Phone: 307-630-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number124
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: