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NPI Code Detail

MEDICARE: HEATHER ROOSE

MEDICARE:   HEATHER  ROOSE
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
1163WS0200XSchool Registered NurseRN145862AZ

General Provider Information

NPI Number : 1952587131
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER ROOSE
Provider Business Mailing Address
First Line : 2200 HAVASUPAI BLVD
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-3122
Country : US
Telephone Number : 928-505-6900
Fax Number :
Provider Business Practice Location Address
First Line : 2200 HAVASUPAI BLVD
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-3122
Country : US
Telephone Number : 928-505-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2008
Last Update Date : 01/17/2008

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Directions to “ HEATHER ROOSE ” Practice Location

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