Provider Demographics
NPI:1306826664
Name:ROSE, SHERRY ELLEN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ELLEN
Last Name:ROSE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25860 CONCORD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070
Mailing Address - Country:US
Mailing Address - Phone:248-545-1830
Mailing Address - Fax:248-545-1830
Practice Address - Street 1:510 EMERICK
Practice Address - Street 2:WELLNESS CENTER
Practice Address - City:TPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198
Practice Address - Country:US
Practice Address - Phone:734-714-1409
Practice Address - Fax:734-714-1440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704101057-1511732163W00000X
MI4704101057-1511660163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics