Provider Demographics
NPI:1023749512
Name:MEDROSE HEALTH PLLC
Entity type:Organization
Organization Name:MEDROSE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUMBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:602-574-6620
Mailing Address - Street 1:3133 W FRYE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5132
Mailing Address - Country:US
Mailing Address - Phone:888-712-0724
Mailing Address - Fax:888-610-3402
Practice Address - Street 1:3133 W FRYE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5132
Practice Address - Country:US
Practice Address - Phone:888-712-0724
Practice Address - Fax:888-610-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care MedicineGroup - Multi-Specialty