=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063921104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSA NARDO PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2017
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 MATTHEW ST STE 201
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45750-1656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-568-4590
-----------------------------------------------------
Fax | 740-568-4592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 458 CROSS RD
-----------------------------------------------------
City | BELPRE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45714-8139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-827-3721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 50.005241RX
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------