Provider Demographics
NPI:1376625582
Name:ROSE, HEIDI ALAHN (NP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ALAHN
Last Name:ROSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:HEIDI
Other - Middle Name:ALAHN
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:1495 RIVER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4517
Mailing Address - Country:US
Mailing Address - Phone:916-925-7020
Mailing Address - Fax:916-925-3680
Practice Address - Street 1:1495 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4517
Practice Address - Country:US
Practice Address - Phone:916-925-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557389163WC0400X
CA95003885363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0400XNursing Service ProvidersRegistered NurseCase Management