Provider Demographics
NPI:1437460755
Name:NOAH, ROSE A (LPN)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:A
Last Name:NOAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:OR
Mailing Address - Zip Code:97119-7885
Mailing Address - Country:US
Mailing Address - Phone:503-985-7846
Mailing Address - Fax:
Practice Address - Street 1:320 PARK ST
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:OR
Practice Address - Zip Code:97119-7885
Practice Address - Country:US
Practice Address - Phone:503-985-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000005773LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse