Provider Demographics
NPI:1881246833
Name:PSARA, ROSE M (APRN)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:M
Last Name:PSARA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, PMHNP-BC
Mailing Address - Street 1:11116 S TOWNE SQ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7850
Mailing Address - Country:US
Mailing Address - Phone:314-567-1958
Mailing Address - Fax:
Practice Address - Street 1:11116 S TOWNE SQ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7850
Practice Address - Country:US
Practice Address - Phone:314-567-1958
Practice Address - Fax:314-567-0037
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019025836363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health