Provider Demographics
NPI:1790473163
Name:ROSE, LAURA MICHELE (FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELE
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16466 BERNARDO CENTER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2522
Mailing Address - Country:US
Mailing Address - Phone:858-453-7700
Mailing Address - Fax:858-798-1225
Practice Address - Street 1:16466 BERNARDO CENTER DR STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2522
Practice Address - Country:US
Practice Address - Phone:858-453-7700
Practice Address - Fax:858-798-1225
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95137543163W00000X
CA95024950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse