Provider Demographics
NPI:1265437032
Name:ROSE, PAULA SUE (CRNA)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:SUE
Last Name:ROSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5281N 99TH AVE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3105
Mailing Address - Country:US
Mailing Address - Phone:623-241-6158
Mailing Address - Fax:623-691-8502
Practice Address - Street 1:19636 N 2TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4013
Practice Address - Country:US
Practice Address - Phone:623-516-8252
Practice Address - Fax:623-516-8253
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2425367500000X
AZCRNA0375367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC2425Medicare UPIN
AZZ187458Medicare PIN