Healthcare Provider Details

I. General information

NPI: 1073007100
Provider Name (Legal Business Name): ROSEBERTHE OPONT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 MAIN ST APT 429
BRIDGEPORT CT
06606-4212
US

IV. Provider business mailing address

2900 MAIN ST APT 429
BRIDGEPORT CT
06606-4212
US

V. Phone/Fax

Practice location:
  • Phone: 203-434-4604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number747819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: