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General NPI Number Information
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NPI Number | 1295042984
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Entity Type | Individual
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Provider Name | MARI PAT ROSE RN, BSN
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Gender | Female
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 1407 SAINT ANDREW ST STE 100
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City | LA CROSSE
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State | WI
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Zip | 54603-2378
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Country | US
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Telephone | 608-785-6266
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Fax | 608-785-6315
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Provider Business Mailing Address
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Address Line | 817 GEORGE ST
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City | LA CROSSE
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State | WI
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Zip | 54603-2673
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Country | US
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Telephone | 608-519-1121
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 167141-30
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License Number State | WI
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