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General NPI Number Information
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NPI Number | 1336187863
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Entity Type | Individual
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Provider Name | MARILYN ANN ROTHENBERG C.N.M.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 9021 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3726
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Country | US
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Telephone | 313-871-1926
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Fax | 313-871-1964
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Provider Business Mailing Address
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Address Line | 9021 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3726
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Country | US
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Telephone | 313-871-1926
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Fax | 313-871-1964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704123676
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 4704123676
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License Number State | MI
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