Provider Demographics
NPI:1356853295
Name:ROSE, CHARNELLE (DNP, APRN-C, WHNP-BC)
Entity type:Individual
Prefix:
First Name:CHARNELLE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:DNP, APRN-C, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2221
Mailing Address - Country:US
Mailing Address - Phone:405-592-7053
Mailing Address - Fax:405-983-0707
Practice Address - Street 1:903 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6828
Practice Address - Country:US
Practice Address - Phone:405-592-7053
Practice Address - Fax:405-983-0707
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0103958363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health