Provider Demographics
NPI:1619927795
Name:OLDS, ROSE B (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:B
Last Name:OLDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:370 E SOUTH TEMPLE
Mailing Address - Street 2:STE 550
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1206
Mailing Address - Country:US
Mailing Address - Phone:801-537-7070
Mailing Address - Fax:801-355-9322
Practice Address - Street 1:370 E SOUTH TEMPLE
Practice Address - Street 2:STE 550
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1206
Practice Address - Country:US
Practice Address - Phone:801-537-7070
Practice Address - Fax:801-355-9322
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT2152474405364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health