Provider Demographics
NPI:1578767372
Name:ROSENBAUM, JANICE B (CRNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:B
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:B
Other - Last Name:ROSSMAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:800 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:218-829-7923
Mailing Address - Fax:215-829-8690
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-7923
Practice Address - Fax:215-829-8690
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003858C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA214857Medicare PIN
PAS46480Medicare UPIN