Provider Demographics
NPI:1467885715
Name:ROSE, SANDRA LYNN (CNM)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LYNN
Last Name:ROSE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-4058
Mailing Address - Country:US
Mailing Address - Phone:304-920-5127
Mailing Address - Fax:
Practice Address - Street 1:75 LYNN DR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4058
Practice Address - Country:US
Practice Address - Phone:304-920-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001202294163W00000X
PARN681404163W00000X
PAMW010403367A00000X
VA0024190566367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse