Healthcare Provider Details

I. General information

NPI: 1548213473
Provider Name (Legal Business Name): ROSALEE C. BERTUCCI RNC,NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY NEONATOLOGY SERVICES
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

5714 DEANS BRIDGE RD
BLYTHE GA
30805-3431
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-2891
  • Fax: 706-774-2664
Mailing address:
  • Phone: 706-592-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN0422166 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: