Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Crea Rose

Individual provider Nurse Practitioner · NPI 1366184053

Crea Rose is a Nurse Practitioner in Salem, Illinois. Qualified in 2022, 4 years ago. Practices with Revival Health and Wellness Clinic, a 2-clinician group. Licensed in Illinois.

Years since qualifying
4
Licensed in
IL
In the registry since
2022

Practice location Address checks out

207 E Main St
Salem, IL 62881-2926
Phone: (618) 740-2240
Fax: (618) 740-2241
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 209.025104 (IL)

Record details

NPI number1366184053
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 12, 2022
Last updated in NPPESApril 19, 2026
Certification dateApril 19, 2026
Mailing address207 E Main St, Salem, IL 62881-2926

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Revival Health And Wellness Clinic — 2 clinicians
Accepts Medicare assignment Not indicated

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