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1548148422 NPI number — KESSIAH SERENA ROSARIO

NPI Number: 1548148422
Health Care Provider/Practitioner: KESSIAH SERENA ROSARIO

Information about “1548148422” NPI (KESSIAH SERENA ROSARIO) exists in 1548148422 in HTML format HTML  |  1548148422 in plain Text format TXT  |  1548148422 in PDF (Portable Document Format) PDF  |  1548148422 in an XML format XML  formats.

NPI Number : 1548148422 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548148422",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROSARIO",
    "FirstName": "KESSIAH",
    "MiddleName": "SERENA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROLAND",
    "OtherFirstName": "KESSIAH",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1058 FAWNRIDGE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEWFOUNDLAND",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "18445-7736",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "610-390-7563",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2214 5TH ST STE 5",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WHITE BEAR LAKE",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55110-3039",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "833-946-4436",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/26/2025",
    "LastUpdateDate": "08/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "SP031319",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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