Provider Demographics
NPI:1063276541
Name:ROSE, CHRISTINE (RN (COMPACT LICENSE))
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:RN (COMPACT LICENSE)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21035 SYCOLIN RD STE 55
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4311
Mailing Address - Country:US
Mailing Address - Phone:703-496-4616
Mailing Address - Fax:703-496-4615
Practice Address - Street 1:21035 SYCOLIN RD STE 55
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4311
Practice Address - Country:US
Practice Address - Phone:703-496-4616
Practice Address - Fax:703-496-4615
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001314218163WI0500X, 163WP0200X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0200XNursing Service ProvidersRegistered NursePediatrics