Provider Demographics
NPI:1003867417
Name:CIPRES-JAUCIAN, ROSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:M
Last Name:CIPRES-JAUCIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 SPRING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-8369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1723 SPRING HILLS LN
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-8369
Practice Address - Country:US
Practice Address - Phone:920-403-7982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056207A2080N0001X
WI22782-202080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200935420Medicaid
WI34540600Medicaid
009906261IOtherHUMANA
IN000000603384OtherANTHEM PROVIDER NUMBER
009906261IOtherHUMANA
0002907520Medicare ID - Type Unspecified
IN000000603384OtherANTHEM PROVIDER NUMBER