Provider Demographics
NPI:1336119700
Name:ROSE, BEVERLY SUE (NP)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:SUE
Last Name:ROSE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:4922 SPYGLASS VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5671
Mailing Address - Country:US
Mailing Address - Phone:210-916-3723
Mailing Address - Fax:210-916-4733
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-3723
Practice Address - Fax:210-916-4733
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health