MEDICARE: MS. SANDRA LYNN ROSE CNM

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	367A00000X	Advanced Practice Midwife	323	NC
2	367A00000X	Advanced Practice Midwife	0024190566	VA
3	163W00000X	Registered Nurse	RN681404	PA
4	367A00000X	Advanced Practice Midwife	MW010403	PA
5	163W00000X	Registered Nurse	0001202294	VA

General Provider Information

NPI Number	:	1467885715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA LYNN ROSE CNM

Provider Business Mailing Address
First Line	:	75 LYNN DR
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-4058
Country	:	US
Telephone Number	:	304-920-5127
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 LYNN DR
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-4058
Country	:	US
Telephone Number	:	304-920-5127
Fax Number	:

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

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	03/03/2026

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