Healthcare Provider Details

I. General information

NPI: 1043710312
Provider Name (Legal Business Name): CAROLIN HAEUSLER ROSSAVIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SUMMIT CROSSING PL STE 108A
GASTONIA NC
28054-2189
US

IV. Provider business mailing address

620 SUMMIT CROSSING PL STE 108A
GASTONIA NC
28054-2189
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-2229
  • Fax: 704-865-2811
Mailing address:
  • Phone: 704-865-2229
  • Fax: 704-865-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2024-02466
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: