Provider Demographics
NPI:1033300439
Name:EASH, ROSEMARY J (FNP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:J
Last Name:EASH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:1627 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3817
Practice Address - Country:US
Practice Address - Phone:574-262-0313
Practice Address - Fax:574-262-8163
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000526A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100389920Medicaid
IN000000872147OtherBCBS BMG PEDIATRICS BRISTOL STREET
IN236040093Medicare PIN