Provider Demographics
NPI:1285686097
Name:ROSE, ANN W (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:W
Last Name:ROSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COBURG RD.
Mailing Address - Street 2:#201
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-726-4686
Mailing Address - Fax:541-726-5056
Practice Address - Street 1:10 COBURG RD.
Practice Address - Street 2:#201
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-726-4686
Practice Address - Fax:541-726-5056
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00290363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136523Medicaid
ORS15526Medicare UPIN
OR130076Medicare PIN