Healthcare Provider Details

I. General information

NPI: 1750761078
Provider Name (Legal Business Name): ROZANA KI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 GUILFORD DR STE 100
FREDERICK MD
21704-5198
US

IV. Provider business mailing address

22509 CASTLE OAK RD
CLARKSBURG MD
20871-3345
US

V. Phone/Fax

Practice location:
  • Phone: 240-464-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR181136
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number181136
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: