Provider Demographics
NPI:1497933840
Name:ROSE, CAROLYN ANNE (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANNE
Last Name:ROSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 LANDMARK DR
Mailing Address - Street 2:#300
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5999
Mailing Address - Country:US
Mailing Address - Phone:435-615-3915
Mailing Address - Fax:435-615-3926
Practice Address - Street 1:6505 LANDMARK DR
Practice Address - Street 2:#300
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5999
Practice Address - Country:US
Practice Address - Phone:435-615-3915
Practice Address - Fax:435-615-3926
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT217756-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse