Basic Information
| Provider Information | |||||||||
| NPI: | 1699704247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 GENN DR | ||||||||
| Address2: | |||||||||
| City: | WAMEGO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665471179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854562295 | ||||||||
| FaxNumber: | 7854569467 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 GENN DR | ||||||||
| Address2: | |||||||||
| City: | WAMEGO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665471179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854562295 | ||||||||
| FaxNumber: | 7854569467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 13-26942-082 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 13-26942-082 | 01 | KS | REGISTERED NURSE | OTHER | 54153 | 01 | KS | REG. NURSE ANESTHETIST | OTHER | 144577 | 01 | KS | BLUE CROSS PROVIDER # | OTHER | 54153 | 01 | KS | ARNP | OTHER |