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General NPI Number Information
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NPI Number | 1427344977
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Entity Type | Individual
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Provider Name | ROSARIO WALTER BOGART CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 131 MEDICAL PARK RD 308
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City | MOORESVILLE
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State | NC
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Zip | 28117-8522
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Country | US
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Telephone | 704-662-0876
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Fax | 704-662-0875
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Provider Business Mailing Address
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Address Line | 146 MEDICAL PARK RD STE 108
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City | MOORESVILLE
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State | NC
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Zip | 28117-8529
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Country | US
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Telephone | 704-662-0877
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Fax | 704-662-0875
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 087329
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License Number State | PA
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