Provider Demographics
NPI:1174854657
Name:ROSEBAUGH, NANCY L (ANP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:ROSEBAUGH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CROASDAILE FARM PKWY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1331
Mailing Address - Country:US
Mailing Address - Phone:919-384-2571
Mailing Address - Fax:919-384-2649
Practice Address - Street 1:2600 CROASDAILE FARM PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1331
Practice Address - Country:US
Practice Address - Phone:919-384-2571
Practice Address - Fax:919-384-2649
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily