Provider Demographics
NPI:1295042984
Name:ROSE, MARI PAT (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:MARI
Middle Name:PAT
Last Name:ROSE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MS
Other - First Name:MARI
Other - Middle Name:PAT
Other - Last Name:RETHWISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:817 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-2673
Mailing Address - Country:US
Mailing Address - Phone:608-519-1121
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST STE 100
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2378
Practice Address - Country:US
Practice Address - Phone:608-785-6266
Practice Address - Fax:608-785-6315
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167141-30163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health