Provider Demographics
NPI:1659676369
Name:ROSA, RALPH ANDREW (REGISTERED NURSE(RN))
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:ANDREW
Last Name:ROSA
Suffix:
Gender:M
Credentials:REGISTERED NURSE(RN)
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Mailing Address - Street 1:189 STORRS ROAD
Mailing Address - Street 2:(CT ROUTE 195) NATCHAUG HOSPITAL
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250
Mailing Address - Country:US
Mailing Address - Phone:860-456-1311
Mailing Address - Fax:860-423-6114
Practice Address - Street 1:189 STORRS ROAD
Practice Address - Street 2:(CT ROUTE 195) NATCHAUG HOSPITAL
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250
Practice Address - Country:US
Practice Address - Phone:860-456-1311
Practice Address - Fax:860-423-6114
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CTE58366163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse