1336387695 NPI number — MRS. CHRISTINE ROSSETTI NP-C

Table of content: MRS. CHRISTINE ROSSETTI NP-C (NPI 1336387695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336387695 NPI number — MRS. CHRISTINE ROSSETTI NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSSETTI
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336387695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20265 EMERY RD
Provider Second Line Business Mailing Address:
#255
Provider Business Mailing Address City Name:
NORTH RANDALL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44128-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-523-9966
Provider Business Mailing Address Fax Number:
216-584-2895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25000 COUNTRY CLUB BLVD
Provider Second Line Business Practice Location Address:
#255
Provider Business Practice Location Address City Name:
NORTH OLMSTED
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44070-5344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-893-0200
Provider Business Practice Location Address Fax Number:
440-793-7194
Provider Enumeration Date:
01/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  A0908110 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A0908110 . This is a "OHIO LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com