Provider Demographics
NPI:1033527403
Name:ROSE, AMY MARIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ROSE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:16 MOORELAND ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4414
Mailing Address - Country:US
Mailing Address - Phone:603-560-5583
Mailing Address - Fax:
Practice Address - Street 1:16 MOORELAND ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4414
Practice Address - Country:US
Practice Address - Phone:603-560-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2266004363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health