Healthcare Provider Details

I. General information

NPI: 1144238957
Provider Name (Legal Business Name): HEATHER LYNN ROSSI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2629
US

IV. Provider business mailing address

1055 WESTGATE DR SUITE 190
SAINT PAUL MN
55114-1065
US

V. Phone/Fax

Practice location:
  • Phone: 651-312-1717
  • Fax: 651-312-1570
Mailing address:
  • Phone: 651-312-1500
  • Fax: 651-312-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number46615
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: