Provider Demographics
NPI:1376540039
Name:GEPHART, ROSANNE (CNM, NP, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:ROSANNE
Middle Name:
Last Name:GEPHART
Suffix:
Gender:F
Credentials:CNM, NP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5263 BEAUMONT WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2861
Mailing Address - Country:US
Mailing Address - Phone:707-538-4781
Mailing Address - Fax:707-539-0686
Practice Address - Street 1:3630 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3212
Practice Address - Country:US
Practice Address - Phone:619-299-0840
Practice Address - Fax:619-291-5098
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW744363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW744OtherNURSE-MIDWIFE LICENCE NUM