Provider Demographics
NPI:1457082570
Name:VANDENBERG, ROSINE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ROSINE
Middle Name:
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S GREGG ST STE 226
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2425
Mailing Address - Country:US
Mailing Address - Phone:432-652-2548
Mailing Address - Fax:877-654-8355
Practice Address - Street 1:710 S GREGG ST STE 226
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2425
Practice Address - Country:US
Practice Address - Phone:432-652-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1084635363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health