Healthcare Provider Details

I. General information

NPI: 1093364911
Provider Name (Legal Business Name): WHITNEY RONDELL ROSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9049 SPRINGBORO PIKE
MIAMISBURG OH
45342-4926
US

IV. Provider business mailing address

9049 SPRINGBORO PIKE
MIAMISBURG OH
45342-4926
US

V. Phone/Fax

Practice location:
  • Phone: 937-759-0545
  • Fax: 937-759-0549
Mailing address:
  • Phone: 937-759-0545
  • Fax: 937-759-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.006111RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006111RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: