Provider Demographics
NPI:1073773529
Name:MAHAN, ROSEMARY A (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:A
Last Name:MAHAN
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:ANGELA
Other - Last Name:MAHAN
Other - Suffix:V
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:HSC TOWER 11 ROOM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-7720
Mailing Address - Fax:631-444-2785
Practice Address - Street 1:DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:HEALTH SCIENCES CENTER TOWER 11 ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-7720
Practice Address - Fax:631-444-7865
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380497-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics