Healthcare Provider Details

I. General information

NPI: 1376737445
Provider Name (Legal Business Name): MARY ELIZABETH ROSENSTIEL RN, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 12/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39641 SCENIC ST
SANDY OR
97055-6405
US

IV. Provider business mailing address

18702 SE RICHEY RD
GRESHAM OR
97080-3323
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-5545
  • Fax: 503-668-7951
Mailing address:
  • Phone: 503-492-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number79-032717
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: