Provider Demographics
NPI:1013386200
Name:MEJIA PEREZ, ROSA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ROSA
Middle Name:
Last Name:MEJIA PEREZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 WALNUT ST
Mailing Address - Street 2:APT 12
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2903
Mailing Address - Country:US
Mailing Address - Phone:608-844-3869
Mailing Address - Fax:
Practice Address - Street 1:123 SHATO LN
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3795
Practice Address - Country:US
Practice Address - Phone:815-238-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319425-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse