Individual
VICKI L ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1230 E MAIN ST, MANKATO, MN 56002-8674
(507) 625-1811
Mailing address
PO BOX 8674, 1230 E MAIN ST, MANKATO, MN 56002-8674
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9544
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0109946
MEDICA
MN
01
—
140087
UCARE
MN
01
—
2409706
AMERICAS PPO
MN
01
—
41084933956001C220
CHAMPUS
—
01
—
57B74RO
BCBS
MN
05
—
741190100
—
MN
01
—
HP30956
HEALTH PARTNERS
MN
01
—
NA2951024933
PREFERRED ONE
MN
Enumeration date
01/10/2006
Last updated
07/15/2020
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