Provider Demographics
NPI:1043392731
Name:ROSETTA, CHARLOTTE ELIZABETH (LVN)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ELIZABETH
Last Name:ROSETTA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 BARNES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-2154
Mailing Address - Country:US
Mailing Address - Phone:214-324-0041
Mailing Address - Fax:
Practice Address - Street 1:2109 BARNES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-2154
Practice Address - Country:US
Practice Address - Phone:214-324-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37734385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child