1225069727 NPI number — DR. LINDA SUE ROSE DC

Table of content: DR. LINDA SUE ROSE DC (NPI 1225069727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225069727 NPI number — DR. LINDA SUE ROSE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSE
Provider First Name:
LINDA
Provider Middle Name:
SUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS ROSE
Provider Other First Name:
LINDA
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225069727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 W WISHKAH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98520-6133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-533-6920
Provider Business Mailing Address Fax Number:
360-533-8005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W WISHKAH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98520-6133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-533-6920
Provider Business Practice Location Address Fax Number:
360-533-8005
Provider Enumeration Date:
07/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00001157 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0028719 . This is a "L AND I" identifier . This identifiers is of the category "OTHER".
  • Identifier: 029084001 . This is a "GRP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: R03511 . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2004646 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".