Provider Demographics
NPI:1285839050
Name:ROONEY, ROSE ROGSTAD (PAC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ROGSTAD
Last Name:ROONEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:ROGSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:800 E 101ST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-5122
Mailing Address - Country:US
Mailing Address - Phone:425-501-3738
Mailing Address - Fax:
Practice Address - Street 1:6485 CITY WEST PKWY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3246
Practice Address - Country:US
Practice Address - Phone:952-933-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003688363A00000X
MN9700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant