MEDICARE: MS. ANNA MARIE DEROOSE CRNP, CPNP

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	363LP0200X	Pediatric Nurse Practitioner	R089564	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437121969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNA MARIE DEROOSE CRNP, CPNP

Provider Business Mailing Address
First Line	:	1792 MERRITT BLVD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222
Country	:	US
Telephone Number	:	410-284-1133
Fax Number	:	410-284-3371

Provider Business Practice Location Address
First Line	:	1792 MERRITT BLVD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222
Country	:	US
Telephone Number	:	410-284-1133
Fax Number	:	410-284-3371

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	04/20/2016

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