Provider Demographics
NPI:1619639374
Name:ENNEY, ROSE M (RN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:ENNEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:STAVEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5500 COUNTY ROAD 15 W
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-8617
Mailing Address - Country:US
Mailing Address - Phone:701-509-1710
Mailing Address - Fax:
Practice Address - Street 1:5500 COUNTY ROAD 15 W
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-8617
Practice Address - Country:US
Practice Address - Phone:701-509-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant