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General NPI Number Information
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NPI Number | 1184160293
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Entity Type | Individual
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Provider Name | JUSTIN SCOTT ROSE CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 100 15TH ST NW
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City | NORTON
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State | VA
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Zip | 24273-1616
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Country | US
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Telephone | 276-439-1425
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Fax |
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Provider Business Mailing Address
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Address Line | 933 OLD WILDERNESS RD
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City | SALTVILLE
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State | VA
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Zip | 24370-4229
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Country | US
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Telephone | 276-782-5757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024174579
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001231492
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License Number State | VA
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