Provider Demographics
NPI:1508941600
Name:DENNIS, ROSETTA M (APN)
Entity Type:Individual
Prefix:MS
First Name:ROSETTA
Middle Name:M
Last Name:DENNIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:320A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4216
Mailing Address - Country:US
Mailing Address - Phone:215-503-7654
Mailing Address - Fax:215-955-2010
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:320A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:215-503-7654
Practice Address - Fax:215-955-2010
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN229825L363L00000X, 363LN0000X, 363LN0005X
PASP006783J363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4030443Medicaid
NJ0007897Medicaid
078056SAJMedicare PIN
PA078056PAGMedicare PIN
NJ0007897Medicaid