Healthcare Provider Details

I. General information

NPI: 1689731077
Provider Name (Legal Business Name): DONNA RENEE ROSEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6012 MAIN ST
VOORHEES NJ
08043-4659
US

IV. Provider business mailing address

6012 MAIN ST
VOORHEES NJ
08043-4659
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-6622
  • Fax: 856-325-6522
Mailing address:
  • Phone: 856-325-6622
  • Fax: 856-325-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberUP001226G
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNJ00061600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: