Healthcare Provider Details

I. General information

NPI: 1407056229
Provider Name (Legal Business Name): ANN PRESTON ROSELLE ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WASHINGTON AVE
HAMDEN CT
06518-3271
US

IV. Provider business mailing address

60 WASHINGTON AVENUE
HAMDEN CT
06518
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-0414
  • Fax:
Mailing address:
  • Phone: 203-288-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR176044
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAC0004111
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number004769
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: