Provider Demographics
NPI:1881663185
Name:ROSE, ANDREW N (PA C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:N
Last Name:ROSE
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 WHIPPLE AVE # 30
Mailing Address - Street 2:
Mailing Address - City:LOGANDALE
Mailing Address - State:NV
Mailing Address - Zip Code:89021-9934
Mailing Address - Country:US
Mailing Address - Phone:702-398-3621
Mailing Address - Fax:702-398-3626
Practice Address - Street 1:1925 WHIPPLE AVE # 30
Practice Address - Street 2:
Practice Address - City:LOGANDALE
Practice Address - State:NV
Practice Address - Zip Code:89021
Practice Address - Country:US
Practice Address - Phone:702-398-3621
Practice Address - Fax:023-983-6267
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1560363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200359270AMedicaid
KS0000426927OtherBLUE CROSS
KS0000426927OtherBLUE CROSS
KSP00280381Medicare PIN
KS016830004Medicare PIN