Provider Demographics
NPI:1710997820
Name:FAULKNER, ROSALIE (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SYLVIA DR
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2719
Mailing Address - Country:US
Mailing Address - Phone:631-539-4840
Mailing Address - Fax:
Practice Address - Street 1:301 EAST MAIN STREET
Practice Address - Street 2:DEPARTMENT OF CARDIOLOGY
Practice Address - City:BAYSHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-968-3171
Practice Address - Fax:631-968-3819
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304403-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health