Provider Demographics
NPI:1659529832
Name:DIERCKSEN, ROSEMARIE E (FNP)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:E
Last Name:DIERCKSEN
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 1:36 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2818
Mailing Address - Country:US
Mailing Address - Phone:845-358-2880
Mailing Address - Fax:845-358-2880
Practice Address - Street 1:10 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1529
Practice Address - Country:US
Practice Address - Phone:914-231-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-31
Last Update Date:2008-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1223G1Medicare PIN
NYQ51016Medicare UPIN