Provider Demographics
NPI:1790906196
Name:ROSENBAUM, AMY LYNNE (MSN, NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ROSENBAUM-WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2323
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:1809 NATIONAL AVENUE
Practice Address - Street 2:LOGAN HEIGHTS FAMILY HEALTH CENTERS
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3538
Practice Address - Country:US
Practice Address - Phone:619-515-2300
Practice Address - Fax:619-234-2447
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA504418Medicare UPIN