Healthcare Provider Details

I. General information

NPI: 1366643397
Provider Name (Legal Business Name): MRS. RENEE MARIE ROSTETTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 BRISTOL RD
NEW RICHMOND OH
45157-9767
US

IV. Provider business mailing address

1075 BRISTOL RD
NEW RICHMOND OH
45157-9767
US

V. Phone/Fax

Practice location:
  • Phone: 513-553-3933
  • Fax:
Mailing address:
  • Phone: 513-553-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN101252
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: