Provider Demographics
NPI:1245361278
Name:MCCORMICK, DENISE ROSKOVENSKY (ARNP)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ROSKOVENSKY
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:ROSKOVENSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:USAHC KATTERBACH
Mailing Address - Street 2:CMR 454 BOX 1025
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09250
Mailing Address - Country:DE
Mailing Address - Phone:0114998-118-3811
Mailing Address - Fax:0114998-118-3854
Practice Address - Street 1:USA MEDDAC BAVARIA
Practice Address - Street 2:UNIT 26610 CREDENTIALS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244
Practice Address - Country:DE
Practice Address - Phone:011499318-042-2291
Practice Address - Fax:0114998-118-3854
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007526363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN