Healthcare Provider Details

I. General information

NPI: 1467490946
Provider Name (Legal Business Name): LORRAINE ROKOSZAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

318 AUTUMN LN
STROUDSBURG PA
18360-8043
US

V. Phone/Fax

Practice location:
  • Phone: 201-321-3671
  • Fax:
Mailing address:
  • Phone: 201-321-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00047800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: