Provider Demographics
NPI:1851913271
Name:PITA-ROMAN, ROSSIEL (NP)
Entity Type:Individual
Prefix:
First Name:ROSSIEL
Middle Name:
Last Name:PITA-ROMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OAK RIDGE AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4480
Mailing Address - Country:US
Mailing Address - Phone:978-697-0036
Mailing Address - Fax:
Practice Address - Street 1:25 OAK RIDGE AVE APT 10
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4480
Practice Address - Country:US
Practice Address - Phone:978-697-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily