Provider Demographics
NPI:1154865939
Name:FERNANDEZ, RHOSE VILLAREZ (CCDS, APRN-FNP)
Entity Type:Individual
Prefix:MRS
First Name:RHOSE
Middle Name:VILLAREZ
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CCDS, APRN-FNP
Other - Prefix:MRS
Other - First Name:RHOSE
Other - Middle Name:ANDAG
Other - Last Name:VILLAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35364 LANA LN
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3856
Mailing Address - Country:US
Mailing Address - Phone:586-838-6680
Mailing Address - Fax:
Practice Address - Street 1:35364 LANA LN
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3856
Practice Address - Country:US
Practice Address - Phone:586-838-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704233933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5695066Medicare PIN