Provider Demographics
NPI:1023248671
Name:ROSE, REBECCA LYNNE (CPM, LM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:ROSE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3003
Mailing Address - Country:US
Mailing Address - Phone:505-254-7615
Mailing Address - Fax:505-242-6445
Practice Address - Street 1:231 MCMANUS RD
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958-3510
Practice Address - Country:US
Practice Address - Phone:505-514-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM09055R175M00000X
L-316346174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No175M00000XOther Service ProvidersMidwife, Lay