Provider Demographics
NPI:1700874385
Name:TROTTA, ROSEMARY T (MS, RN, APRN-BC)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:T
Last Name:TROTTA
Suffix:
Gender:F
Credentials:MS, RN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 GREEN BAY RD BLDG 9
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:224-610-3784
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD BLDG 9
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-08
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2492-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41257300Medicaid