Provider Demographics
NPI:1851585855
Name:ROSENDO, CHARITY T (NP-C)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:T
Last Name:ROSENDO
Suffix:
Gender:F
Credentials:NP-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 N. NELLIS BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110
Mailing Address - Country:US
Mailing Address - Phone:702-383-6240
Mailing Address - Fax:702-459-8586
Practice Address - Street 1:61 N. NELLIS BLVD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110
Practice Address - Country:US
Practice Address - Phone:702-383-6240
Practice Address - Fax:702-459-8586
Is Sole Proprietor?:No
Enumeration Date:2007-09-01
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX819440363LA2200X, 363LF0000X
IL209-005932363LA2200X, 363LF0000X
NVAPRN002759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2048180Medicaid
WAG8945318Medicare PIN