Provider Demographics
NPI:1235233917
Name:ROSE, CHRISTINE ELLEN (RPA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:ROSE
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
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Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-554-3119
Mailing Address - Fax:585-554-3323
Practice Address - Street 1:213 STATE ROUTE 245
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9604
Practice Address - Country:US
Practice Address - Phone:585-554-3119
Practice Address - Fax:585-554-3323
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005136-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ59335Medicare UPIN