Provider Demographics
NPI:1912949041
Name:ROSE, JILANNE (NP)
Entity Type:Individual
Prefix:
First Name:JILANNE
Middle Name:
Last Name:ROSE
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 1:2155 E CONFERENCE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2604
Mailing Address - Country:US
Mailing Address - Phone:480-454-5562
Mailing Address - Fax:480-868-2272
Practice Address - Street 1:2155 E CONFERENCE DR
Practice Address - Street 2:STE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2604
Practice Address - Country:US
Practice Address - Phone:480-454-5562
Practice Address - Fax:480-868-2272
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN131906163W00000X
AZAP2134363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMR1276713OtherDEA
AZQ46766Medicare UPIN
AZ103907Medicare ID - Type Unspecified