Provider Demographics
NPI:1770541666
Name:HAQUE, ROSE A (APN CNS)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:A
Last Name:HAQUE
Suffix:
Gender:F
Credentials:APN CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7300 W COLLEGE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-448-8470
Mailing Address - Fax:708-448-9651
Practice Address - Street 1:7300 W COLLEGE DR
Practice Address - Street 2:101
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-448-8470
Practice Address - Fax:708-448-9651
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
K12414Medicare UPIN