Provider Demographics
NPI:1780768028
Name:SALTCLAH, ROSE (NP)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:SALTCLAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 N BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2357
Mailing Address - Country:US
Mailing Address - Phone:505-566-1915
Mailing Address - Fax:505-566-1918
Practice Address - Street 1:3451 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2357
Practice Address - Country:US
Practice Address - Phone:505-566-1915
Practice Address - Fax:505-566-1918
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR23620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13534084Medicaid
AZP99864Medicare UPIN
AZ8HR67Medicare ID - Type Unspecified
AZ8HR67Medicare ID - Type Unspecified