Individual
MRS. KATIE MICHELLE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1639 N ALPINE RD STE 360, ROCKFORD, IL 61107-1440
(815) 229-9333
Mailing address
1639 N ALPINE RD STE 360, ROCKFORD, IL 61107-1440
(515) 979-9508
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.008991
IL
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/29/2020
Last updated
02/20/2023
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