Provider Demographics
NPI:1720536840
Name:CROSE, AREZOU (FNP)
Entity Type:Individual
Prefix:
First Name:AREZOU
Middle Name:
Last Name:CROSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 DOUGLAS BLVD
Mailing Address - Street 2:STE 325
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4289
Mailing Address - Country:US
Mailing Address - Phone:925-787-8030
Mailing Address - Fax:
Practice Address - Street 1:3978 SILVER LACE LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-6303
Practice Address - Country:US
Practice Address - Phone:925-787-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95004947364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health