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General NPI Number Information
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NPI Number | 1396557146
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Entity Type | Individual
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Provider Name | KANDANCE ROSE NP
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 2045 HAMILTON BLVD
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2141
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Country | US
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Telephone | 434-572-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 1048 SNOW HILL RD
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City | ALTON
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State | VA
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Zip | 24520-3148
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Country | US
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Telephone | 434-579-1713
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024190235
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License Number State | VA
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