Rose, Audra J

Rose, Audra J is an individual health care provider with primary practice located at 3450 Potomac Way , Idaho Falls ID 83404-7407. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is her primary health care specialty. Rose, Audra J can be contacted via phone (208) 557-2900.

Contact Information

Primary practice address
3450 Potomac Way Idaho Falls ID 83404-7407
Phone: (208) 557-2900
Fax: (208) 557-2910
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X TL403 Wyoming
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X M6628 Idaho

Profile Details

NPI number 1487877619
LBN Legal business name Rose, Audra J
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2007
Last updated Dec 29th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487877619 NPPES
Idaho MEDICAID 807761500

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