Provider Demographics
NPI:1912638669
Name:PADRO, ROSA INES (RN, FNP)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:INES
Last Name:PADRO
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BURNS RD
Mailing Address - Street 2:
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9561
Mailing Address - Country:US
Mailing Address - Phone:607-342-2396
Mailing Address - Fax:
Practice Address - Street 1:177 BURNS RD
Practice Address - Street 2:
Practice Address - City:BROOKTONDALE
Practice Address - State:NY
Practice Address - Zip Code:14817-9561
Practice Address - Country:US
Practice Address - Phone:607-342-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533392163W00000X
NYF349699-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse