MEDICARE: MS. SANDY DAVINA ROSSMAN MSN, ANP-BC

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	363LA2200X	Adult Health Nurse Practitioner	RN078917	GA

General Provider Information

NPI Number	:	1467695668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDY DAVINA ROSSMAN MSN, ANP-BC

Provider Business Mailing Address
First Line	:	1146 SAINT AUGUSTINE PL NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4521
Country	:	US
Telephone Number	:	404-892-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1146 SAINT AUGUSTINE PL NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4521
Country	:	US
Telephone Number	:	404-892-6366
Fax Number	:

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

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	03/11/2010

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