Provider Demographics
NPI:1548498470
Name:HEPBURN, ROSE M (LVN)
Entity type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:M
Last Name:HEPBURN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2313
Mailing Address - Country:US
Mailing Address - Phone:707-464-3191
Mailing Address - Fax:707-465-6701
Practice Address - Street 1:880 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2313
Practice Address - Country:US
Practice Address - Phone:707-464-3191
Practice Address - Fax:707-465-6701
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN242734164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse