Provider Demographics
NPI:1578629945
Name:PROUHET, ROSA M (CNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:M
Last Name:PROUHET
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:ROSA
Other - Middle Name:M
Other - Last Name:PALOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8080 STATE ST
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62203-1808
Mailing Address - Country:US
Mailing Address - Phone:618-397-3303
Mailing Address - Fax:618-397-7802
Practice Address - Street 1:818 UPPER CAHOKIA RD
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-1212
Practice Address - Country:US
Practice Address - Phone:618-310-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041275771163W00000X
MO124452163W00000X, 363L00000X
IL209006099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse