Provider Demographics
NPI:1245408673
Name:ROSE, WENDY JANE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JANE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 BRIGGS RANCH DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2276
Mailing Address - Country:US
Mailing Address - Phone:916-284-0380
Mailing Address - Fax:916-351-5990
Practice Address - Street 1:3466 DATA DR APT 411
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7959
Practice Address - Country:US
Practice Address - Phone:916-284-0380
Practice Address - Fax:916-351-5990
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN116483164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse