Basic Information
| Provider Information | |||||||||
| NPI: | 1184646671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDRIDGE | ||||||||
| FirstName: | ROSE MARY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 8TH ST S | ||||||||
| Address2: | |||||||||
| City: | MOORHEAD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565603604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012343200 | ||||||||
| FaxNumber: | 7012343286 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 8TH ST S | ||||||||
| Address2: | |||||||||
| City: | MOORHEAD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565603604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012343200 | ||||||||
| FaxNumber: | 7012343286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R17871 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.