Provider Demographics
NPI:1013195171
Name:ROSALES, NANCY CONCEPCION (APRN, MSN, FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CONCEPCION
Last Name:ROSALES
Suffix:
Gender:F
Credentials:APRN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5874
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:1050 GAIL GARDNER WAY STE 300
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1640
Practice Address - Country:US
Practice Address - Phone:928-717-5232
Practice Address - Fax:928-717-5238
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN163186OtherRN LICENSE
AZAP3674OtherADV PRACTITIONER LICENSE
MR2413881OtherDEA