Provider Demographics
NPI:1346833464
Name:WAMBOLD, ROSE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:WAMBOLD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17604 NE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-9398
Mailing Address - Country:US
Mailing Address - Phone:603-241-7327
Mailing Address - Fax:
Practice Address - Street 1:17604 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-9398
Practice Address - Country:US
Practice Address - Phone:603-241-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care