MEDICARE: KATHLEEN A ROSAS CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	RN275504L	PA

General Provider Information

NPI Number	:	1447256151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN A ROSAS CRNA

Provider Business Mailing Address
First Line	:	3400 SPRUCE STREET
Second Line	:	6 DULLES
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4206
Country	:	US
Telephone Number	:	215-349-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 SPRUCE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4206
Country	:	US
Telephone Number	:	215-349-8310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/16/2014

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