Provider Demographics
NPI:1730674375
Name:ROSE, BELINDA S (PMHNP)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:S
Last Name:ROSE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4526
Mailing Address - Country:US
Mailing Address - Phone:740-355-7102
Mailing Address - Fax:740-353-3083
Practice Address - Street 1:1634 11TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-355-7102
Practice Address - Fax:740-353-3083
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00024181363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0312959Medicaid
OHAPRN.CNP.022994OtherOHIO LICENSE