Provider Demographics
NPI:1851352389
Name:ROSAS, VIRGINIA KELLI (FNP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:KELLI
Last Name:ROSAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2010
Mailing Address - Country:US
Mailing Address - Phone:406-293-6900
Mailing Address - Fax:406-293-6622
Practice Address - Street 1:320 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2010
Practice Address - Country:US
Practice Address - Phone:434-200-9009
Practice Address - Fax:434-200-9005
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867210363L00000X
TN8395363LF0000X
VA0024170114363LF0000X
MT161179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1851352389Medicaid
VA1851352389Medicaid
TNQ21863Medicare UPIN