Healthcare Provider Details

I. General information

NPI: 1669158333
Provider Name (Legal Business Name): VITA ROSENBERG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 OLD DES PERES RD
DES PERES MO
63131-1865
US

IV. Provider business mailing address

PO BOX 14369
SAINT LOUIS MO
63178-4369
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-0077
  • Fax: 314-729-0101
Mailing address:
  • Phone: 314-729-0077
  • Fax: 314-729-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023024690
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: