Provider Demographics
NPI:1720392822
Name:MICHAELS, ROSE ANNE (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ANNE
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WINDSOR LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-1427
Mailing Address - Country:US
Mailing Address - Phone:304-444-3539
Mailing Address - Fax:
Practice Address - Street 1:111 WINDSOR LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-1427
Practice Address - Country:US
Practice Address - Phone:304-444-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily