Provider Demographics
NPI:1346827722
Name:ROSENBERRY, PATRICIA (AGNP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ROSENBERRY
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14995 SHADY GROVE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8733
Mailing Address - Country:US
Mailing Address - Phone:301-869-7820
Mailing Address - Fax:301-762-2541
Practice Address - Street 1:130 LUBRANO DR STE 111
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7192
Practice Address - Country:US
Practice Address - Phone:410-974-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR173447363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health