Healthcare Provider Details

I. General information

NPI: 1417260498
Provider Name (Legal Business Name): CATHERINE ANN ROSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR411, BLDG. 250, ROSE BARRACKS
APO AE
09112
US

IV. Provider business mailing address

USA MEDDAC BAVARIA CMR411, BLDG. 250, ROSE BARRACKS
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 499662833085
  • Fax:
Mailing address:
  • Phone: 499662833085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number409835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: