Healthcare Provider Details

I. General information

NPI: 1851585855
Provider Name (Legal Business Name): CHARITY T. ROSENDO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2007
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 N. NELLIS BLVD.
LAS VEGAS NV
89110
US

IV. Provider business mailing address

61 N. NELLIS BLVD.
LAS VEGAS NV
89110
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-6240
  • Fax: 702-459-8586
Mailing address:
  • Phone: 702-383-6240
  • Fax: 702-459-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number819440
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-005932
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-005932
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number819440
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002759
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: