Healthcare Provider Details

I. General information

NPI: 1902904618
Provider Name (Legal Business Name): BELEN DE LA ROSA MS, APN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AVE & ROOSEVELT ROAD BUILDING 228, ROOM 3067
HINES IL
60141
US

IV. Provider business mailing address

128 60TH ST
DOWNERS GROVE IL
60516-2037
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-4569
  • Fax:
Mailing address:
  • Phone: 630-852-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: