Provider Demographics
NPI:1699014142
Name:ROSENBERG, ALIZA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ALIZA
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ALIZA
Other - Middle Name:
Other - Last Name:KREBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2024 E BALTIMORE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1941
Mailing Address - Country:US
Mailing Address - Phone:602-670-2098
Mailing Address - Fax:
Practice Address - Street 1:620 N CAROLINE ST
Practice Address - Street 2:STD CLINIC
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1839
Practice Address - Country:US
Practice Address - Phone:410-396-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily