Individual
MS. LISA S. ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5647 US HIGHWAY 26, DUBOIS, WY 82513-9607
(307) 455-2516
(307) 455-2526
Mailing address
5000 BLACKMORE RD, CASPER, WY 82609-3345
(307) 233-6000
(307) 233-6089
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
22672.1509
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144824200
—
WY
Enumeration date
03/31/2016
Last updated
03/22/2022
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