Provider Demographics
NPI:1942478797
Name:ROSI, MARILYN L (FNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:L
Last Name:ROSI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:A
Other - Last Name:ROSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3781 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689
Mailing Address - Country:US
Mailing Address - Phone:989-348-7671
Mailing Address - Fax:989-348-8414
Practice Address - Street 1:1010 W. NORTH DOWN RIVER ROAD
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738
Practice Address - Country:US
Practice Address - Phone:989-348-7671
Practice Address - Fax:989-348-8414
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114965363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B04606010Medicare PIN