Provider Demographics
NPI:1770641854
Name:ROOSE, ALLYSON M (RN)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:M
Last Name:ROOSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 WOODSIDE MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-5119
Mailing Address - Country:US
Mailing Address - Phone:207-363-1403
Mailing Address - Fax:207-282-7509
Practice Address - Street 1:453 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-5513
Practice Address - Country:US
Practice Address - Phone:207-439-8391
Practice Address - Fax:207-282-7509
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERO51615163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health