Individual
CRYSTAL ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9750 NE GLISAN ST, PORTLAND, OR 97220-4449
(928) 671-0904
Mailing address
17180 W SWEETWATER AVE UNIT 1088, SURPRISE, AZ 85388-3404
(928) 671-0904
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202209494
OR
164W00000X
Licensed Practical Nurse
Primary
202209494
OR
Other
Enumeration date
11/28/2022
Last updated
04/17/2024
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