Healthcare Provider Details

I. General information

NPI: 1790761112
Provider Name (Legal Business Name): LAURIE E ROSELLI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2005
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD DAVIS 5 INTENSIVE CARE NURSERY
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

730 HARDWICK DR
AURORA OH
44202-7002
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-3050
  • Fax:
Mailing address:
  • Phone: 916-759-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberNP13933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: