Healthcare Provider Details

I. General information

NPI: 1962407981
Provider Name (Legal Business Name): CAROL N ROWSEMITT PHD, RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 4TH ST # 2
PISMO BEACH CA
93449-3102
US

IV. Provider business mailing address

1845 QUAIL DR
SAN LUIS OBISPO CA
93405-6341
US

V. Phone/Fax

Practice location:
  • Phone: 805-773-3130
  • Fax: 805-773-3120
Mailing address:
  • Phone: 805-782-9704
  • Fax: 805-773-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number556135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: