Provider Demographics
NPI:1326650052
Name:GATHUNGU, ROSEMARY (FNP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:GATHUNGU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-1862
Mailing Address - Country:US
Mailing Address - Phone:574-370-7271
Mailing Address - Fax:
Practice Address - Street 1:1113 MOSSY LN
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-9055
Practice Address - Country:US
Practice Address - Phone:574-208-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010364A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner