Basic Information
| Provider Information | |||||||||
| NPI: | 1578761938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | ALTMAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.N., BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 ROCKEFELLER AVE | ||||||||
| Address2: | 225 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252614910 | ||||||||
| FaxNumber: | 4252614911 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 ROCKEFELLER AVE | ||||||||
| Address2: | 225 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252614910 | ||||||||
| FaxNumber: | 4252614911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 163WC3500X | RN00094282 | WA | Y | Nursing Service Providers | Registered Nurse | Cardiac Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | RN00094282 | 01 | WA | TERESA A. ROSE | OTHER |