Provider Demographics
NPI:1831183326
Name:ROSELAND, WARREN THOMAS JR (MSN, RN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:THOMAS
Last Name:ROSELAND
Suffix:JR
Gender:M
Credentials:MSN, RN, FNP-C
Other - Prefix:MR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:ROSELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, RN, FNP-C
Mailing Address - Street 1:4803 ELKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9424
Mailing Address - Country:US
Mailing Address - Phone:209-769-6112
Mailing Address - Fax:209-720-0139
Practice Address - Street 1:2225 NW STEWART PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1650
Practice Address - Country:US
Practice Address - Phone:541-900-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 409980163WG0000X, 163WM0705X, 163WS0200X
OR201811353363LF0000X
CANP9245363LF0000X, 363LP0808X, 363LP2300X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201811353RNOtherOREGON RN LICENSE
OR500759209Medicaid
CARN049980OtherCA RN LICENSE
OR201811353NP-PPOtherOREGON FNP LICENS
CANP9245OtherCA FNP LICENSE
CANP 9245OtherBRN-CALIF FNP LICENSE
CAXR0488913OtherDEA X-WAIVER LICENSE
CANP 9245OtherBRN-CALIF FNP LICENSE