Provider Demographics
NPI:1376880856
Name:ROSE, ALEXANDRA J (LAC EAMP)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:J
Last Name:ROSE
Suffix:
Gender:F
Credentials:LAC EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 FIFTH AVE NE STE 140
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7471
Mailing Address - Country:US
Mailing Address - Phone:206-440-1634
Mailing Address - Fax:206-374-8202
Practice Address - Street 1:10212 FIFTH AVE NE STE 140
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7471
Practice Address - Country:US
Practice Address - Phone:206-440-1634
Practice Address - Fax:206-374-8202
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61241826171100000X
SD029343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist