Provider Demographics
NPI:1164957742
Name:ROSE, SHAYANNE (EMT)
Entity Type:Individual
Prefix:MS
First Name:SHAYANNE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 HOSPITAL LOOP
Mailing Address - Street 2:P.O. BOX 219
Mailing Address - City:OWYHEE
Mailing Address - State:NV
Mailing Address - Zip Code:89832-1200
Mailing Address - Country:US
Mailing Address - Phone:775-757-2415
Mailing Address - Fax:
Practice Address - Street 1:1623 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:OWYHEE
Practice Address - State:NV
Practice Address - Zip Code:89832-1200
Practice Address - Country:US
Practice Address - Phone:775-757-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV73545146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic