Provider Demographics
NPI:1467415075
Name:ROSENBERG, ANNE LEWIS (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:LEWIS
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:215-456-8305
Mailing Address - Fax:215-456-2386
Practice Address - Street 1:2 PENN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144
Practice Address - Country:US
Practice Address - Phone:215-951-8200
Practice Address - Fax:215-951-8293
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003426G363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
043894Medicare ID - Type Unspecified
P19620Medicare UPIN