Provider Demographics
NPI:1144384678
Name:FENTON, ROSALIND (FNP-BC, GNP-BC)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:FENTON
Suffix:
Gender:F
Credentials:FNP-BC, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PROSPECT PL STE 340B
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1991
Mailing Address - Country:US
Mailing Address - Phone:619-522-4000
Mailing Address - Fax:
Practice Address - Street 1:230 PROSPECT PL STE 340B
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1991
Practice Address - Country:US
Practice Address - Phone:619-522-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361642363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology