Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
JORDAN PROSSER ROSE
Active
Individual
JORDAN PROSSER ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
775622
CA
363LF0000X
Family Nurse Practitioner
Primary
21928
CA
Other
Enumeration date
04/20/2012
Last updated
07/15/2015
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