Healthcare Provider Details

I. General information

NPI: 1316884786
Provider Name (Legal Business Name): TAYLOR ROSENHAGEN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MARYVILLE UNIVERSITY DR
SAINT LOUIS MO
63141-5849
US

IV. Provider business mailing address

126 PARK PLACE DR
MORGANTOWN WV
26508-4521
US

V. Phone/Fax

Practice location:
  • Phone: 724-963-5450
  • Fax:
Mailing address:
  • Phone: 724-963-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number109560
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: