Provider Demographics
NPI:1790481174
Name:ROSE, COLLEEN KAREN (RN)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:KAREN
Last Name:ROSE
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 1:2778 MIMIKA PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5605
Mailing Address - Country:US
Mailing Address - Phone:858-216-6985
Mailing Address - Fax:
Practice Address - Street 1:2778 MIMIKA PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5605
Practice Address - Country:US
Practice Address - Phone:858-216-6985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5696573163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management