Provider Demographics
NPI:1689315541
Name:ROSENDALE, TRISHA ANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANNE
Last Name:ROSENDALE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:ANNE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 NW SOUTH OUTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3069
Mailing Address - Country:US
Mailing Address - Phone:888-256-3814
Mailing Address - Fax:888-256-9054
Practice Address - Street 1:3469 SHELBY 265
Practice Address - Street 2:
Practice Address - City:EMDEN
Practice Address - State:MO
Practice Address - Zip Code:63439-3142
Practice Address - Country:US
Practice Address - Phone:660-651-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022021773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily