Provider Demographics
NPI:1588202071
Name:MOTA, ROSEANN (RN)
Entity type:Individual
Prefix:
First Name:ROSEANN
Middle Name:
Last Name:MOTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROSEANN
Other - Middle Name:
Other - Last Name:MOTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:535 S MESA HILLS DR APT 626
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5673
Mailing Address - Country:US
Mailing Address - Phone:312-493-0362
Mailing Address - Fax:
Practice Address - Street 1:535 S MESA HILLS DR APT 626
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5673
Practice Address - Country:US
Practice Address - Phone:312-493-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX932869163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse