Provider Demographics
NPI:1700466455
Name:FENSTER, ROSEANNE BERMAN
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:BERMAN
Last Name:FENSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1414
Mailing Address - Country:US
Mailing Address - Phone:248-541-0158
Mailing Address - Fax:
Practice Address - Street 1:26540 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1321
Practice Address - Country:US
Practice Address - Phone:248-854-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse