Provider Demographics
NPI:1447781414
Name:ROSSER, CASEY LYNNELL
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNNELL
Last Name:ROSSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 N EMERY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2255
Mailing Address - Country:US
Mailing Address - Phone:480-203-6656
Mailing Address - Fax:
Practice Address - Street 1:3031 OLD CLINIC BUILDING
Practice Address - Street 2:CB#7570
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:984-974-8017
Practice Address - Fax:984-974-8020
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172666207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology