Healthcare Provider Details

I. General information

NPI: 1316923618
Provider Name (Legal Business Name): MARIA ROSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 MARSHALL WAY
PLACERVILLE CA
95667-8238
US

IV. Provider business mailing address

1095 MARSHALL WAY
PLACERVILLE CA
95667-6533
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-2920
  • Fax: 530-626-2974
Mailing address:
  • Phone: 530-626-2920
  • Fax: 530-626-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN176285
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP6385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: