=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053319095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETSY ROSIEK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2005
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 N BROADWAY
-----------------------------------------------------
City | PERU
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46970-1070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-722-5151
-----------------------------------------------------
Fax | 574-739-1414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1307 WILLOW CT
-----------------------------------------------------
City | NOBLESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46062-9145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-385-1430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 01042354A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------