Provider Demographics
NPI:1568698538
Name:ROSE, ROBERT JAMES (LPN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:ROSE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 TENNYSON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3338
Mailing Address - Country:US
Mailing Address - Phone:216-339-0893
Mailing Address - Fax:
Practice Address - Street 1:2706 TENNYSON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3338
Practice Address - Country:US
Practice Address - Phone:216-339-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse