Provider Demographics
NPI:1740016062
Name:ROSE, SANDRA JEAN (MSN, RN, CDCES)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSN, RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15726 W GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6653
Mailing Address - Country:US
Mailing Address - Phone:281-451-2343
Mailing Address - Fax:
Practice Address - Street 1:15726 W GREYSTONE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6653
Practice Address - Country:US
Practice Address - Phone:281-451-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315904163W00000X
TX688871163W00000X
AZ303243163WC0400X, 163WD0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator