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General NPI Number Information
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NPI Number | 1083640247
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Entity Type | Organization
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Legal Business Name | DEAN ROSECRANS
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 424 7TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-4168
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Country | US
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Telephone | 208-467-4790
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Fax | 208-465-5951
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Provider Business Mailing Address
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Address Line | PO BOX 310
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City | NAMPA
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State | ID
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Zip | 83653-0310
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Country | US
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Telephone | 208-467-4790
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Fax | 208-465-5951
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Authorized Official
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Title or Position | OWNER
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Name | DEAN ROSECRANS
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Credential |
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Telephone | 208-466-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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