Healthcare Provider Details

I. General information

NPI: 1437191772
Provider Name (Legal Business Name): EDWARD ESTHER ROSENQUIST PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OAKLEAF WAY SUITE A
ALTOONA WI
54720-2245
US

IV. Provider business mailing address

1200 OAKLEAF WAY SUITE A
ALTOONA WI
54720-2245
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-1400
  • Fax: 715-832-4187
Mailing address:
  • Phone: 715-832-1400
  • Fax: 715-832-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number837-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: