Healthcare Provider Details

I. General information

NPI: 1306336193
Provider Name (Legal Business Name): TIMOTHY ANDREW ROSENBAUM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2663 E KANTZ DR APT 4
FAYETTEVILLE AR
72703-3249
US

IV. Provider business mailing address

2663 E KANTZ DR APT 4
FAYETTEVILLE AR
72703-3249
US

V. Phone/Fax

Practice location:
  • Phone: 414-173-3133
  • Fax:
Mailing address:
  • Phone: 414-173-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR098540
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: