Provider Demographics
NPI:1265552749
Name:ROSE, MARTA KARA CHARLENE (NP)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:KARA CHARLENE
Last Name:ROSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:CHARLENE
Other - Last Name:PRITCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3744 S TIMBERLINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4333
Mailing Address - Country:US
Mailing Address - Phone:970-495-0506
Mailing Address - Fax:
Practice Address - Street 1:3744 S TIMBERLINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4333
Practice Address - Country:US
Practice Address - Phone:970-495-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000145363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14280540Medicaid
CO14280540Medicaid