Provider Demographics
NPI:1710239173
Name:ROSE, LAURA JILL (MSN APRN ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JILL
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSN APRN ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26900 CEDAR RD
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1191
Mailing Address - Country:US
Mailing Address - Phone:216-839-3000
Mailing Address - Fax:
Practice Address - Street 1:26900 CEDAR RD
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1191
Practice Address - Country:US
Practice Address - Phone:216-839-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.318361-COA1163W00000X
OHCOA.13481-NP363LA2200X
OHRX.13481-EX1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse