Provider Demographics
NPI:1487089116
Name:ROSE, KAREN H (BSN, RN, CPED)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:H
Last Name:ROSE
Suffix:
Gender:F
Credentials:BSN, RN, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309-B NASH ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-237-1188
Mailing Address - Fax:252-206-1990
Practice Address - Street 1:309-B NASH ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-237-1188
Practice Address - Fax:252-206-1990
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20989224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795295Medicaid
NC20989OtherCPED CERTIFICATION ID