Provider Demographics
NPI:1346236064
Name:LERZA, ROSEMARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:LERZA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:L
Other - Last Name:CAMPIONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3155 N POINT PKWY
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT., BUILDING F, SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-645-9181
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:1000 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:770-645-9181
Practice Address - Fax:770-645-8455
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115224367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000594525CMedicaid
GA000594525GMedicaid
GA000594525FMedicaid
GA000594525CMedicaid
GAR12314Medicare UPIN
GA43ZCBKG87Medicare PIN