Provider Demographics
NPI:1083054423
Name:HIETKAMP, ROSEMARY (FNP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:HIETKAMP
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 1:38 TAHOE CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0123
Mailing Address - Country:US
Mailing Address - Phone:910-964-9796
Mailing Address - Fax:
Practice Address - Street 1:113 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:910-964-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC184678163W00000X
NC5006258363LF0000X
IAA172297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse