Provider Demographics
NPI:1437191772
Name:ROSENQUIST, EDWARD ESTHER (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ESTHER
Last Name:ROSENQUIST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OAKLEAF WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-832-1400
Mailing Address - Fax:715-832-4187
Practice Address - Street 1:1200 OAKLEAF WAY
Practice Address - Street 2:SUITE A
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-832-1400
Practice Address - Fax:715-832-4187
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI837-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42956400Medicaid
WI44909OtherSECURITY HEALTH PLAN
WI01 14471OtherMEDICA/SELECTCARE CF
WI2400797OtherUNITED HEALTHCARE
WI01 14469OtherMEDICA/SELECTCARE EC
WIP00171102OtherRAILROAD
WI01 14471OtherMEDICA/SELECTCARE CF
WIR02574Medicare UPIN