Provider Demographics
NPI:1619194081
Name:ROSENGREN, DEBORAH JOYCE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JOYCE
Last Name:ROSENGREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 MAPLE GROVE RD
Mailing Address - Street 2:#604
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4571
Mailing Address - Country:US
Mailing Address - Phone:218-720-6254
Mailing Address - Fax:
Practice Address - Street 1:1408 MAPLE GROVE RD
Practice Address - Street 2:#604
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4571
Practice Address - Country:US
Practice Address - Phone:218-720-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 107825-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health