Provider Demographics
NPI:1003381815
Name:ROSSETTA, REBEKAH KATHLEEN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:KATHLEEN
Last Name:ROSSETTA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 DISK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-6638
Mailing Address - Country:US
Mailing Address - Phone:541-773-3863
Mailing Address - Fax:
Practice Address - Street 1:8385 DIVISION RD
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1176
Practice Address - Country:US
Practice Address - Phone:541-773-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10021593363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics