Healthcare Provider Details

I. General information

NPI: 1073550968
Provider Name (Legal Business Name): REGINA MARY UBALDI-ROSEN MSN/CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 DUTTON MILL RD
ASTON PA
19014-2849
US

IV. Provider business mailing address

28 LEA DR
CHADDS FORD PA
19317-8983
US

V. Phone/Fax

Practice location:
  • Phone: 610-485-6700
  • Fax:
Mailing address:
  • Phone: 610-675-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP003371B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: