Provider Demographics
NPI:1548213473
Name:BERTUCCI, ROSALEE C (RNC,NNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSALEE
Middle Name:C
Last Name:BERTUCCI
Suffix:
Gender:F
Credentials:RNC,NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 DEANS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:GA
Mailing Address - Zip Code:30805-3431
Mailing Address - Country:US
Mailing Address - Phone:706-592-2905
Mailing Address - Fax:
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:NEONATOLOGY SERVICES
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-774-2891
Practice Address - Fax:706-774-2664
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN0422166 NP163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care