MRS. STACY RUTH ROSE CRNP NPI 1689658031

NPI Information

NPI: 1689658031
Provider Name: MRS. STACY RUTH ROSE, CRNP
Classification: Nurse Practitioner - 363LW0102X
Entity Type: Individual

Specialization: Women's Health

PECOS Registration: Yes

Address:
4176 STATE ROUTE 306
WILLOUGHBY, OH
ZIP 44094
Phone: (440) 918-4630
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MRS. Stacy Ruth Rose, CRNP is a women's health nurse practitioner in Willoughby, OH. MRS. Stacy Ruth Rose, CRNP NPI is 1689658031. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4176 STATE ROUTE 306
WILLOUGHBY, OH
ZIP 44094-203
Phone: (440) 918-4630
Fax: (440) 918-4620

The NPI 1689658031 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/30/2005 and was last updated on 3/3/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LW0102X	Nurse Practitioner	Women's Health	COA.06089-NP	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2203627	MEDICAID	OHIO
2	H020110	OTHER	OHIO	MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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