Healthcare Provider Details

I. General information

NPI: 1831056571
Provider Name (Legal Business Name): NEMENIFA ROSOKOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 CHERRY AVE NE
KEIZER OR
97303-4924
US

IV. Provider business mailing address

155 PEMBROOK ST SE
SALEM OR
97302-5050
US

V. Phone/Fax

Practice location:
  • Phone: 503-606-7697
  • Fax:
Mailing address:
  • Phone: 971-712-8425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number114856
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: