Provider Demographics
NPI:1306398193
Name:ROSANDICH, CHARLENE M (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:M
Last Name:ROSANDICH
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W323S4258 GRACE CT
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9451
Mailing Address - Country:US
Mailing Address - Phone:262-442-3370
Mailing Address - Fax:
Practice Address - Street 1:W323S4258 GRACE CT
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-9451
Practice Address - Country:US
Practice Address - Phone:262-442-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI97966-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health