Provider Demographics
NPI:1649270851
Name:ROOSA, LYNN (CNP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:ROOSA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 E GUADALUPE RD
Mailing Address - Street 2:#109
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5114
Mailing Address - Country:US
Mailing Address - Phone:480-505-4258
Mailing Address - Fax:480-505-3689
Practice Address - Street 1:6301 S MCCLINTOCK DR
Practice Address - Street 2:#215
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3394
Practice Address - Country:US
Practice Address - Phone:480-820-6657
Practice Address - Fax:480-820-0803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN044558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMR0167393OtherDEA