Provider Demographics
NPI:1871235259
Name:ROSEBOROUGH, RHIANNON MICHELLE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:MICHELLE
Last Name:ROSEBOROUGH
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23038 ENCHANTED LANDING LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7576
Mailing Address - Country:US
Mailing Address - Phone:713-858-1392
Mailing Address - Fax:
Practice Address - Street 1:19100 W LAKE HOUSTON PKWY STE 104
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5139
Practice Address - Country:US
Practice Address - Phone:281-626-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX819943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty