Provider Demographics
NPI:1366786618
Name:MAINA, ROSE N (NP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:N
Last Name:MAINA
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:601 OMEGA DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2075
Mailing Address - Country:US
Mailing Address - Phone:817-465-5881
Mailing Address - Fax:817-465-6336
Practice Address - Street 1:11797 SOUTH FWY
Practice Address - Street 2:STE 330
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7026
Practice Address - Country:US
Practice Address - Phone:817-293-1900
Practice Address - Fax:817-293-4930
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2014-08-26
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Provider Licenses
StateLicense IDTaxonomies
TX808274363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3142937Medicaid
TX267701YKUCMedicare PIN