Provider Demographics
NPI:1831796481
Name:ROSEBRAUGH, ELISSA
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:ROSEBRAUGH
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:69360-0157
Mailing Address - Country:US
Mailing Address - Phone:316-206-3757
Mailing Address - Fax:
Practice Address - Street 1:307 CONRAD ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NE
Practice Address - Zip Code:69360-6503
Practice Address - Country:US
Practice Address - Phone:308-299-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist