Healthcare Provider Details

I. General information

NPI: 1093295693
Provider Name (Legal Business Name): ERIK ROSUM APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST STE B102
DANVERS MA
01923-2764
US

IV. Provider business mailing address

45 FOREST ACRES DR APT F
BRADFORD MA
01835-7040
US

V. Phone/Fax

Practice location:
  • Phone: 888-283-1722
  • Fax:
Mailing address:
  • Phone: 978-473-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN276864
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: