Provider Demographics
NPI:1790473163
Name:ROSE, LAURA MICHELE (FNP-C, RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELE
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD STE 237
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5285
Mailing Address - Country:US
Mailing Address - Phone:951-296-0454
Mailing Address - Fax:909-495-1302
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD STE 237
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5285
Practice Address - Country:US
Practice Address - Phone:951-296-0454
Practice Address - Fax:909-495-1302
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95024950363LF0000X
CA95137543163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse