Provider Demographics
NPI:1356747356
Name:ROSE, BECKY C (AG-ACNP)
Entity type:Individual
Prefix:MS
First Name:BECKY
Middle Name:C
Last Name:ROSE
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-619-6100
Mailing Address - Fax:970-619-6190
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-619-6100
Practice Address - Fax:970-619-6190
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991538-NP363LA2100X, 363L00000X
CORN.0204118163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23980788Medicaid
CO391744YLB8Medicare PIN