Provider Demographics
NPI:1235645672
Name:ROSA, DENISE MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:ROSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PANSY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8685
Mailing Address - Country:US
Mailing Address - Phone:631-905-2002
Mailing Address - Fax:
Practice Address - Street 1:5 PANSY RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8685
Practice Address - Country:US
Practice Address - Phone:631-905-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY584838163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse