MEDICARE: ROSEANNE BERMAN FENSTER

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	163W00000X	Registered Nurse	4704217511	MI

General Provider Information

NPI Number	:	1700466455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEANNE BERMAN FENSTER

Provider Business Mailing Address
First Line	:	2990 12 MILE RD
Second Line	:
City	:	BERKLEY
State	:	MI
Zip	:	48072-1414
Country	:	US
Telephone Number	:	248-541-0158
Fax Number	:

Provider Business Practice Location Address
First Line	:	26540 DUNDEE RD
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1321
Country	:	US
Telephone Number	:	248-854-2285
Fax Number	:

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

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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