Provider Demographics
NPI:1568443810
Name:TURNER, ROSE (NP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 KEM ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2555
Mailing Address - Country:US
Mailing Address - Phone:765-662-4133
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:717 E MAIN
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-1645
Practice Address - Country:US
Practice Address - Phone:765-677-4719
Practice Address - Fax:765-677-4727
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000647A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107230AMedicaid
S87796Medicare UPIN
IN296260HHMedicare PIN