Provider Demographics
NPI:1902410772
Name:ROSENBARGER, ASHLEY KATHLEEN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KATHLEEN
Last Name:ROSENBARGER
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 1:691 W. 600 S.
Mailing Address - Street 2:
Mailing Address - City:CHALMERS
Mailing Address - State:IN
Mailing Address - Zip Code:47929-8238
Mailing Address - Country:US
Mailing Address - Phone:765-427-7552
Mailing Address - Fax:
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-838-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28196768A163WG0100X
IN71011305A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology