Provider Demographics
NPI:1235399635
Name:ROSE, MEGAN ANN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2351 CONNECTICUT AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2477
Mailing Address - Country:US
Mailing Address - Phone:320-259-1411
Mailing Address - Fax:320-259-8967
Practice Address - Street 1:2351 CONNECTICUT AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2477
Practice Address - Country:US
Practice Address - Phone:320-259-1411
Practice Address - Fax:320-259-8967
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1135363AM0700X
MN10442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00629859OtherRAILROAD MEDICARE
MN1235399635Medicaid
MN970003525Medicare PIN