Provider Demographics
NPI:1972963650
Name:ROOSA, KRYSTLE LYNN (ASN, RN)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:LYNN
Last Name:ROOSA
Suffix:
Gender:F
Credentials:ASN, RN
Other - Prefix:MISS
Other - First Name:KRYSTLE
Other - Middle Name:LYNN
Other - Last Name:LEWICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:917 ROOSA RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1064
Mailing Address - Country:US
Mailing Address - Phone:412-770-4746
Mailing Address - Fax:
Practice Address - Street 1:917 ROOSA RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1064
Practice Address - Country:US
Practice Address - Phone:412-770-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0033987163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse