Provider Demographics
NPI:1720424716
Name:ROOSA, BETHANY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:ANN
Last Name:ROOSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S CRAPO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2941
Mailing Address - Country:US
Mailing Address - Phone:989-772-5930
Mailing Address - Fax:989-775-7701
Practice Address - Street 1:301 S CRAPO ST STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-5930
Practice Address - Fax:989-775-7701
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse