Provider Demographics
NPI:1275540791
Name:ROTHMAN, ANNETTE ELAINE (CPNP, CNS)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:ELAINE
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:CPNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1624
Mailing Address - Country:US
Mailing Address - Phone:775-239-1050
Mailing Address - Fax:
Practice Address - Street 1:338 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1624
Practice Address - Country:US
Practice Address - Phone:775-239-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001609364SP0807X, 363LP0200X
CO57885363LP0200X, 364SP0807X
NV76721363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54726336Medicaid
NV1275540791Medicaid
CO54726336Medicaid