Healthcare Provider Details

I. General information

NPI: 1710078159
Provider Name (Legal Business Name): AMY TEMPLE ROSENBERGER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ROANOKE AVE
ELIZABETH CITY NC
27909-5643
US

IV. Provider business mailing address

605 BOSLEY RD
SUNBURY NC
27979-9601
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-4400
  • Fax: 252-338-4440
Mailing address:
  • Phone: 252-331-3269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number183712
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013946
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: