MEDICARE: MRS. MICHELLE ROSE ARP RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	041430873	IL

General Provider Information

NPI Number	:	1255922803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE ROSE ARP RN

Provider Business Mailing Address
First Line	:	2701 17TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5393
Country	:	US
Telephone Number	:	309-779-7500
Fax Number	:	309-779-7505

Provider Business Practice Location Address
First Line	:	2701 17TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5393
Country	:	US
Telephone Number	:	309-779-7500
Fax Number	:	309-779-7505

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

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/27/2021

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