Provider Demographics
NPI:1245834878
Name:ROSEWOOD MEDICINE LLC
Entity type:Organization
Organization Name:ROSEWOOD MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:435-268-2363
Mailing Address - Street 1:PO BOX 910876
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-0876
Mailing Address - Country:US
Mailing Address - Phone:435-268-2363
Mailing Address - Fax:435-215-2563
Practice Address - Street 1:2162 E 2800 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6235
Practice Address - Country:US
Practice Address - Phone:435-268-2363
Practice Address - Fax:435-215-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care