Provider Demographics
NPI:1932784733
Name:ROSENBERG, KATRINA WILLA DLL (RN)
Entity Type:Individual
Prefix:
First Name:KATRINA WILLA
Middle Name:DLL
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:106 ELLERY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4498
Mailing Address - Country:US
Mailing Address - Phone:617-999-2234
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1099
Practice Address - Country:US
Practice Address - Phone:617-591-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310047163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse