Provider Demographics
NPI:1821860669
Name:ROSTON, MENDER L
Entity Type:Individual
Prefix:MS
First Name:MENDER
Middle Name:L
Last Name:ROSTON
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 1:2215 MURCHISON RD STE F
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3567
Mailing Address - Country:US
Mailing Address - Phone:472-202-1342
Mailing Address - Fax:
Practice Address - Street 1:105 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4463
Practice Address - Country:US
Practice Address - Phone:910-476-5421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care