Provider Demographics
NPI:1336789916
Name:DEL ROSARIO, RHEA LOU VALDEZ (PMHNP)
Entity Type:Individual
Prefix:
First Name:RHEA LOU
Middle Name:VALDEZ
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S POKEGAMA AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4208
Mailing Address - Country:US
Mailing Address - Phone:218-999-0018
Mailing Address - Fax:218-999-9627
Practice Address - Street 1:1255 S POKEGAMA AVE UNIT 11
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4208
Practice Address - Country:US
Practice Address - Phone:218-999-0018
Practice Address - Fax:218-999-9627
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7164363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty