Provider Demographics
NPI:1609015577
Name:ROSE, REBECCA JUDENE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JUDENE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:JUDENE
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 JACK FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-4586
Mailing Address - Country:US
Mailing Address - Phone:712-246-7485
Mailing Address - Fax:712-246-7036
Practice Address - Street 1:1 JACK FOSTER DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-4586
Practice Address - Country:US
Practice Address - Phone:712-246-7485
Practice Address - Fax:712-246-7036
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248293-1208600000X
IA38581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7728720Medicaid
IAP00805363OtherRR MEDICARE
IA00606Medicaid
NE10025458000Medicaid
260558OtherMIDLANDS
NE10025458000Medicaid
IA1952466419Medicare Oscar/Certification