Provider Demographics
NPI:1427411677
Name:ROSE, SALLY (FNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2903
Mailing Address - Country:US
Mailing Address - Phone:831-424-2903
Mailing Address - Fax:831-758-4094
Practice Address - Street 1:45 E SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2903
Practice Address - Country:US
Practice Address - Phone:831-424-2903
Practice Address - Fax:831-758-4094
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily