Provider Demographics
NPI:1295393379
Name:BAINS, ROSEANNA PAULI (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSEANNA
Middle Name:PAULI
Last Name:BAINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROSEANNA
Other - Middle Name:MEADE
Other - Last Name:PAULI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3005 DOUGLAS BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3885
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3005 DOUGLAS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3885
Practice Address - Country:US
Practice Address - Phone:916-742-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant