Provider Demographics
NPI:1578282703
Name:ROSE, CHRISTINE C
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:C
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31715 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5207
Mailing Address - Country:US
Mailing Address - Phone:216-926-8525
Mailing Address - Fax:
Practice Address - Street 1:2084 EDENHALL DR
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-3828
Practice Address - Country:US
Practice Address - Phone:216-926-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN175172163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse