Provider Demographics
NPI:1093055683
Name:DE LA ROSA, ERIN NICOLE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:NICOLE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:664 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4165
Mailing Address - Country:US
Mailing Address - Phone:845-667-7111
Mailing Address - Fax:
Practice Address - Street 1:664 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4165
Practice Address - Country:US
Practice Address - Phone:845-667-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse