Healthcare Provider Details

I. General information

NPI: 1740018050
Provider Name (Legal Business Name): ROSANN MARIE DARGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 MAIN ST STE 300
KANSAS CITY MO
64108-1318
US

IV. Provider business mailing address

3248 S 77TH ST
MILWAUKEE WI
53219-3742
US

V. Phone/Fax

Practice location:
  • Phone: 920-265-5719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number234250-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: