Provider Demographics
NPI:1932810751
Name:ROSEBERRY, BLAKE ERIN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:ERIN
Last Name:ROSEBERRY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BLAKE
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1429 N 6TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1019
Mailing Address - Country:US
Mailing Address - Phone:812-242-3175
Mailing Address - Fax:
Practice Address - Street 1:1429 N 6TH ST FL 4
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1019
Practice Address - Country:US
Practice Address - Phone:812-242-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28205992A207RC0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease