Provider Demographics
NPI:1619420239
Name:ROSE, CAROLYN M (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:ROSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3552
Mailing Address - Country:US
Mailing Address - Phone:831-566-3653
Mailing Address - Fax:
Practice Address - Street 1:90 BRODIN LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-0507
Practice Address - Country:US
Practice Address - Phone:831-566-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386175163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health