Provider Demographics
NPI:1619572930
Name:NEEDHAM, ROSEANNA MARIE (BS)
Entity Type:Individual
Prefix:
First Name:ROSEANNA
Middle Name:MARIE
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6614
Mailing Address - Country:US
Mailing Address - Phone:817-688-8229
Mailing Address - Fax:
Practice Address - Street 1:813 DORAL DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6614
Practice Address - Country:US
Practice Address - Phone:817-688-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker