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NPI Code Detail

MEDICARE: AMY ROSELIUS

MEDICARE:   AMY  ROSELIUS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner1-090081AL
2363LG0600XGerontology Nurse Practitioner1-090081AL

General Provider Information

NPI Number : 1184090359
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ROSELIUS
Provider Business Mailing Address
First Line : 3124 ROSS CLARK CIR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-3038
Country : US
Telephone Number : 334-678-9123
Fax Number : 334-678-9124
Provider Business Practice Location Address
First Line : 3124 ROSS CLARK CIR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-3038
Country : US
Telephone Number : 334-678-9123
Fax Number : 334-678-9124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2015
Last Update Date : 08/11/2015

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Directions to “ AMY ROSELIUS ” Practice Location

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