Provider Demographics
NPI:1669779120
Name:ROSE, NATALIE (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-761-1977
Mailing Address - Fax:303-761-2787
Practice Address - Street 1:3515 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-3529
Practice Address - Country:US
Practice Address - Phone:303-788-0782
Practice Address - Fax:303-762-1583
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA006058363AM0700X
COPA.0003637363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical