Healthcare Provider Details

I. General information

NPI: 1457523110
Provider Name (Legal Business Name): ROSELORE FEQUIERE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLDE WORTHINGTON RD
WESTERVILLE OH
43082-8913
US

IV. Provider business mailing address

2339 CLEVELAND AVE
COLUMBUS OH
43211-1609
US

V. Phone/Fax

Practice location:
  • Phone: 614-843-2285
  • Fax:
Mailing address:
  • Phone: 614-843-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN337119
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0027688
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027688
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: