Provider Demographics
NPI:1508818758
Name:ROSE, CYNTHIA DENISE (NNP)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:DENISE
Last Name:ROSE
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SHAMROCK ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4241
Mailing Address - Country:US
Mailing Address - Phone:907-563-0326
Mailing Address - Fax:907-562-6445
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:SUITE 366
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4616
Practice Address - Country:US
Practice Address - Phone:907-563-3026
Practice Address - Fax:907-562-6445
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7957363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP4031Medicaid