Provider Demographics
NPI:1639456981
Name:SANDERS-DAVIS, ROSEMARY VIRGINIA (FNP)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:VIRGINIA
Last Name:SANDERS-DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7744 JELLICO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4510
Mailing Address - Country:US
Mailing Address - Phone:805-901-0117
Mailing Address - Fax:
Practice Address - Street 1:7744 JELLICO AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4510
Practice Address - Country:US
Practice Address - Phone:805-901-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily