Provider Demographics
NPI:1669190708
Name:CANTWIL, ROSELYN (PA-C)
Entity type:Individual
Prefix:
First Name:ROSELYN
Middle Name:
Last Name:CANTWIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 N MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2219
Mailing Address - Country:US
Mailing Address - Phone:810-922-8542
Mailing Address - Fax:
Practice Address - Street 1:3827 N MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2219
Practice Address - Country:US
Practice Address - Phone:810-922-8542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant