Provider Demographics
NPI:1770036717
Name:HARTER, ROSEANNE
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:HARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 PACIFIC ST
Mailing Address - Street 2:209
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4799
Mailing Address - Country:US
Mailing Address - Phone:402-934-3303
Mailing Address - Fax:
Practice Address - Street 1:10730 PACIFIC ST
Practice Address - Street 2:209
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4799
Practice Address - Country:US
Practice Address - Phone:402-934-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath