Individual
TRACY SUE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 502-4000
(765) 502-4001
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71013031A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71013031A
IN
Other
Enumeration date
11/14/2022
Last updated
04/06/2023
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