Basic Information
| Provider Information | |||||||||
| NPI: | 1427324920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | JAIMIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN, WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712613529 | ||||||||
| FaxNumber: | 7037535613 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 FLETCHER DR STE 3 | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712613529 | ||||||||
| FaxNumber: | 7037535613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2012 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 0024169987 | VA | N | Nursing Service Providers | Licensed Practical Nurse | 363L00000X | 0024169987 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.