Provider Demographics
NPI:1164780078
Name:MCGINN, ROSEANNA JEAN (NA)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANNA
Middle Name:JEAN
Last Name:MCGINN
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GRACELAND RD
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-6170
Mailing Address - Country:US
Mailing Address - Phone:505-864-6168
Mailing Address - Fax:
Practice Address - Street 1:5 GRACELAND RD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-6170
Practice Address - Country:US
Practice Address - Phone:505-864-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information