Jordan Rose
Nurse Practitioner, Psych/Mental Health in Santa Rosa, CA. Individual provider (NPI-1).
NPI number1164095964
StatusActive
Last updated in NPPESJun 26, 2024
Details
- NPI
- 1164095964
- Entity type
- Individual (NPI-1)
- Name
- Jordan Rose
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 20, 2021
- Certification date
- Jun 26, 2024
- Last updated
- Jun 26, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 95025794 | CA | Yes |
| 163W00000X | Registered Nurse | 95224646 | CA |
Practice location
1287 Fulton RdSanta Rosa, CA 95401-4923
Phone 707-800-7700
Mailing address
Po Box 464Mill Valley, CA 94942-0464
Phone 707-800-7700
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