Provider Demographics
NPI:1336540764
Name:PAIM, ROSANE
Entity Type:Individual
Prefix:
First Name:ROSANE
Middle Name:
Last Name:PAIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSANE
Other - Middle Name:S
Other - Last Name:PAIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2334 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1841
Mailing Address - Country:US
Mailing Address - Phone:630-432-1479
Mailing Address - Fax:
Practice Address - Street 1:2334 VISTA DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1841
Practice Address - Country:US
Practice Address - Phone:630-432-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.355284163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse