Provider Demographics
NPI:1033780739
Name:LA ROSE, CHRISTOPHER JOE (FNP, ANP, NP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOE
Last Name:LA ROSE
Suffix:
Gender:M
Credentials:FNP, ANP, NP
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 481
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-0481
Mailing Address - Country:US
Mailing Address - Phone:417-231-1210
Mailing Address - Fax:
Practice Address - Street 1:300 E 8TH ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343-1199
Practice Address - Country:US
Practice Address - Phone:308-282-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20211016497363LP2300X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty