Healthcare Provider Details

I. General information

NPI: 1386170298
Provider Name (Legal Business Name): LAKISHA ROZIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MCCLELLAN AVE STE 300
PENNSAUKEN NJ
08109-0001
US

IV. Provider business mailing address

2500 MCCLELLAN AVE STE 300
PENNSAUKEN NJ
08109-0001
US

V. Phone/Fax

Practice location:
  • Phone: 856-361-1100
  • Fax: 856-488-1450
Mailing address:
  • Phone: 856-361-1100
  • Fax: 856-488-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR15385400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: