ROSE M ROTH-BOWERSOCK PNP-BC NPI 1417937020

NPI Information

  • NPI: 1417937020
  • Provider Name: ROSE M ROTH-BOWERSOCK, PNP-BC
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 451 HEALTH PKWY
    SUITE E
    PAW PAW, MI
    ZIP 49079
  • Phone: (269) 655-3090

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NPI Details

Rose M Roth-bowersock, PNP-BC is a pediatrics nurse practitioner in Paw Paw, MI. Rose M Roth-bowersock, PNP-BC NPI is 1417937020. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

451 HEALTH PKWY
SUITE E
PAW PAW, MI
ZIP 49079-242
Phone: (269) 655-3090
Fax: (269) 655-0763

The NPI 1417937020 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 1/19/2006 and was last updated on 10/15/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatrics470420936MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H06012727 - BLHMEDICARE PINMICHIGAN
21235131137OTHERMICHIGANBCBSM - BLH
3S11064MEDICARE UPIN
40N54580003MEDICARE PINMICHIGAN
54469434MEDICAIDMICHIGAN
61417937020MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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