Healthcare Provider Details

I. General information

NPI: 1902372048
Provider Name (Legal Business Name): PATRICIA ROSENBERGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 W AZTEC BLVD
AZTEC NM
87410-1800
US

IV. Provider business mailing address

1118 W AZTEC BLVD
AZTEC NM
87410-1800
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-9474
  • Fax:
Mailing address:
  • Phone: 505-334-9474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberRN-70813
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: