Provider Demographics
NPI:1770828204
Name:ROSA, HEIDI MICHELLE (RN, BSN, CNOR, RNFA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MICHELLE
Last Name:ROSA
Suffix:
Gender:F
Credentials:RN, BSN, CNOR, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19878 NAPLES LAKES TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5255
Mailing Address - Country:US
Mailing Address - Phone:770-880-5573
Mailing Address - Fax:
Practice Address - Street 1:1069 W BROAD ST
Practice Address - Street 2:SUITE 908
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4610
Practice Address - Country:US
Practice Address - Phone:877-230-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001178703163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant