Healthcare Provider Details

I. General information

NPI: 1871946780
Provider Name (Legal Business Name): MARTHA ROSENSTEIN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 11/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 E 104TH AVE
ANCHORAGE AK
99507-6844
US

IV. Provider business mailing address

5701 E 104TH AVE
ANCHORAGE AK
99507-6844
US

V. Phone/Fax

Practice location:
  • Phone: 907-317-8179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113414
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: