Provider Demographics
NPI:1902064983
Name:ROSE, SUE ELLEN (RN NPC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:ROSE
Suffix:
Gender:F
Credentials:RN NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 GROVE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-559-3700
Mailing Address - Fax:
Practice Address - Street 1:72 HAMBURG TPKE STE B
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1158
Practice Address - Country:US
Practice Address - Phone:973-696-6687
Practice Address - Fax:833-488-1216
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07063700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily