Healthcare Provider Details

I. General information

NPI: 1295258572
Provider Name (Legal Business Name): MARINE ALEXANDRA ROSSETTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 ISHERWOOD ST NE APT 4
WASHINGTON DC
20002
US

IV. Provider business mailing address

1516 ISHERWOOD ST NE APT 4
WASHINGTON DC
20002-5521
US

V. Phone/Fax

Practice location:
  • Phone: 888-709-0961
  • Fax:
Mailing address:
  • Phone: 888-709-0961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number217-2-1019
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number20110506
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number21721019
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: