MEDICARE: MS. CAROLYN ROSENTHAL NP

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	1058992	KY

General Provider Information

NPI Number	:	1306020425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN ROSENTHAL NP

Provider Business Mailing Address
First Line	:	1722 TREVILIAN WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2057
Country	:	US
Telephone Number	:	502-459-2933
Fax Number	:

Provider Business Practice Location Address
First Line	:	289 IRELAND AVE
Second Line	:	IRELAND ARMY COMMUNITY HOSPITAL
City	:	FT. KNOX
State	:	KY
Zip	:	40121
Country	:	US
Telephone Number	:	314-744-4280
Fax Number	:

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

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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