Provider Demographics
NPI:1093973802
Name:DUBOIS, ROSALYN ANNE (FNP, GNP)
Entity Type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:ANNE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:FNP, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8593
Mailing Address - Country:US
Mailing Address - Phone:607-739-0962
Mailing Address - Fax:
Practice Address - Street 1:44 HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8593
Practice Address - Country:US
Practice Address - Phone:607-739-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335017363LF0000X
NYF340618363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology