Provider Demographics
NPI:1932699444
Name:ROSE, TERRI JO (FNP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:JO
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27201 ALVO RD
Mailing Address - Street 2:
Mailing Address - City:ALVO
Mailing Address - State:NE
Mailing Address - Zip Code:68304-2019
Mailing Address - Country:US
Mailing Address - Phone:402-440-2576
Mailing Address - Fax:
Practice Address - Street 1:16909 LAKESIDE HILLS CT STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4661
Practice Address - Country:US
Practice Address - Phone:402-440-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEAPPLYING207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine