Provider Demographics
NPI:1942770185
Name:VICKERY, ROSEMARIE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:
Last Name:VICKERY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:MCGETTIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:30 S VALLEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1469
Mailing Address - Country:US
Mailing Address - Phone:267-358-6155
Mailing Address - Fax:717-738-6735
Practice Address - Street 1:30 S VALLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1469
Practice Address - Country:US
Practice Address - Phone:610-962-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019614363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health