MEDICARE: ROSE GOURE ARNP, AGPCNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	AP 60445525	WA

General Provider Information

NPI Number	:	1144620964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE GOURE ARNP, AGPCNP-BC

Provider Business Mailing Address
First Line	:	3615 LARRABEE AVE
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-3219
Country	:	US
Telephone Number	:	360-738-3615
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 LARRABEE AVE
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-3219
Country	:	US
Telephone Number	:	360-738-3615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/28/2014

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