Healthcare Provider Details

I. General information

NPI: 1427843549
Provider Name (Legal Business Name): ROSALYN KOTLYN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 HONEYGOLD LN
BROADVIEW HTS OH
44147-3630
US

IV. Provider business mailing address

1414 HONEYGOLD LN
BROADVIEW HTS OH
44147-3630
US

V. Phone/Fax

Practice location:
  • Phone: 440-570-7266
  • Fax:
Mailing address:
  • Phone: 440-570-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.270403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: