Provider Demographics
NPI:1003661430
Name:NNACHO, ROSELINE N
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:N
Last Name:NNACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3573 FORT MEADE RD APT 207
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2083
Mailing Address - Country:US
Mailing Address - Phone:507-318-0527
Mailing Address - Fax:
Practice Address - Street 1:3573 FORT MEADE RD APT 207
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2083
Practice Address - Country:US
Practice Address - Phone:507-318-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator