Provider Demographics
NPI:1114560646
Name:DEROSENA, RACHELLE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:DEROSENA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-3366
Mailing Address - Country:US
Mailing Address - Phone:630-253-5223
Mailing Address - Fax:
Practice Address - Street 1:131 E AMES CT
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2317
Practice Address - Country:US
Practice Address - Phone:516-414-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421413363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health