Provider Demographics
NPI:1457371890
Name:ROSE, NOREEN ELLEN (NP)
Entity type:Individual
Prefix:
First Name:NOREEN
Middle Name:ELLEN
Last Name:ROSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NOREEN
Other - Middle Name:ELLEN
Other - Last Name:KUEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1136 WESTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2175
Mailing Address - Country:US
Mailing Address - Phone:920-456-2023
Mailing Address - Fax:920-456-2025
Practice Address - Street 1:1136 WESTOWNE DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956
Practice Address - Country:US
Practice Address - Phone:920-456-2023
Practice Address - Fax:920-456-2025
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1277-33363L00000X
WI1277-033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457371890Medicaid