Provider Demographics
NPI:1447319363
Name:WERTZ, ROSE (NP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:WERTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 E ORMAN AVE STE A235
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3556
Mailing Address - Country:US
Mailing Address - Phone:719-557-3666
Mailing Address - Fax:719-557-3633
Practice Address - Street 1:1925 E ORMAN AVE STE A235
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3556
Practice Address - Country:US
Practice Address - Phone:719-557-3666
Practice Address - Fax:719-557-3633
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4816363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care