Provider Demographics
NPI:1639214869
Name:LASTER, ROSALYN TAYLOR (RN ES)
Entity Type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:TAYLOR
Last Name:LASTER
Suffix:
Gender:F
Credentials:RN ES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-2879
Mailing Address - Country:US
Mailing Address - Phone:731-784-5491
Mailing Address - Fax:731-784-1726
Practice Address - Street 1:149 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-2879
Practice Address - Country:US
Practice Address - Phone:731-784-5491
Practice Address - Fax:731-784-1726
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011440363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health