Provider Demographics
NPI:1003179821
Name:ROSENBERGER, LARRY L II (CNP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:L
Last Name:ROSENBERGER
Suffix:II
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8738
Mailing Address - Country:US
Mailing Address - Phone:419-427-1984
Mailing Address - Fax:419-427-2864
Practice Address - Street 1:7595 COUNTY ROAD 236
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8738
Practice Address - Country:US
Practice Address - Phone:419-427-1984
Practice Address - Fax:419-427-2864
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13402-NP363L00000X
OHCOA.13402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066679Medicaid
OHH148330Medicare PIN