MEDICARE: AMY ELAINE ROSSITER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	222190	AZ

General Provider Information

NPI Number	:	1104410661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELAINE ROSSITER LPN

Provider Business Mailing Address
First Line	:	PO BOX 86537
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85754-6537
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:	520-372-7126

Provider Business Practice Location Address
First Line	:	1021 E PALMDALE ST STE 130
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-1859
Country	:	US
Telephone Number	:	520-407-5353
Fax Number	:	520-372-7370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/25/2021

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