Provider Demographics
NPI:1639302417
Name:ROSEWOOD PROFESSIONAL CENTER, LLC
Entity Type:Organization
Organization Name:ROSEWOOD PROFESSIONAL CENTER, LLC
Other - Org Name:ROSEWOOD HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:KREMER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, RNFA
Authorized Official - Phone:509-679-2276
Mailing Address - Street 1:PO BOX 1719
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-1719
Mailing Address - Country:US
Mailing Address - Phone:509-888-2209
Mailing Address - Fax:509-888-9449
Practice Address - Street 1:414 E. WOODIN AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9648
Practice Address - Country:US
Practice Address - Phone:509-888-2209
Practice Address - Fax:509-888-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00095775163WM0705X, 164W00000X
WAAP60045990363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8878810Medicare PIN