Provider Demographics
NPI:1336798677
Name:ROSKA, CAMLINH NGUYEN (NP)
Entity Type:Individual
Prefix:
First Name:CAMLINH
Middle Name:NGUYEN
Last Name:ROSKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CAMLINH
Other - Middle Name:NGUYEN
Other - Last Name:ROSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:15109 CATALINA DR APT 2SW
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4360
Mailing Address - Country:US
Mailing Address - Phone:708-704-5383
Mailing Address - Fax:
Practice Address - Street 1:9139 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1303
Practice Address - Country:US
Practice Address - Phone:708-387-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019707363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner