Provider Demographics
NPI:1922433457
Name:FORD, ROSILYN (NP)
Entity Type:Individual
Prefix:
First Name:ROSILYN
Middle Name:
Last Name:FORD
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 1:220 RESERVOIR ST.
Mailing Address - Street 2:SUITE 21
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494
Mailing Address - Country:US
Mailing Address - Phone:781-429-7755
Mailing Address - Fax:781-449-5992
Practice Address - Street 1:220 RESERVOIR ST.
Practice Address - Street 2:SUITE 21
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494
Practice Address - Country:US
Practice Address - Phone:781-429-7755
Practice Address - Fax:781-449-5992
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280029163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse