Provider Demographics
NPI:1093121063
Name:FLINCHUM, ROSE MARIE (CNS, RN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:FLINCHUM
Suffix:
Gender:F
Credentials:CNS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 STATE ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3185
Mailing Address - Country:US
Mailing Address - Phone:219-326-1234
Mailing Address - Fax:219-325-7682
Practice Address - Street 1:1300 STATE ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3185
Practice Address - Country:US
Practice Address - Phone:219-326-1234
Practice Address - Fax:219-325-7682
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28069463A163W00000X
IL041278685163W00000X
INCDE 0942-0223163WD0400X
INNOT REQUIRED IN IN364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator