Provider Demographics
NPI:1407569783
Name:ROSENBAUM, JENNA ANN (CNA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 5TH AVE # 64
Mailing Address - Street 2:
Mailing Address - City:FINGAL
Mailing Address - State:ND
Mailing Address - Zip Code:58031-4023
Mailing Address - Country:US
Mailing Address - Phone:701-840-1736
Mailing Address - Fax:
Practice Address - Street 1:107 5TH AVE # 64
Practice Address - Street 2:
Practice Address - City:FINGAL
Practice Address - State:ND
Practice Address - Zip Code:58031-4023
Practice Address - Country:US
Practice Address - Phone:701-840-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant