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General NPI Number Information
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NPI Number | 1992060206
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Entity Type | Individual
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Provider Name | CHARLES EDWARD ROSE FNP
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Gender | Male
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 14 GRANITE ST
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City | TAUNTON
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State | MA
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Zip | 02780-3009
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Country | US
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Telephone | 508-880-0911
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 98
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City | EAST TAUNTON
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State | MA
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Zip | 02718-0098
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Country | US
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Telephone | 508-880-0911
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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 | 205742
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License Number State | MA
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