Provider Demographics
NPI:1407578537
Name:ROSDAIL, HEATHER SUSAN (APRN- PMHNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUSAN
Last Name:ROSDAIL
Suffix:
Gender:F
Credentials:APRN- PMHNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:SUSAN
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:241 CRENSHAW CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6644
Mailing Address - Country:US
Mailing Address - Phone:916-521-6280
Mailing Address - Fax:
Practice Address - Street 1:3017 DOUGLAS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3850
Practice Address - Country:US
Practice Address - Phone:707-343-9455
Practice Address - Fax:707-205-1503
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023102363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health