MEDICARE: ROSETTA FAIR

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	376K00000X	Nurse's Aide	401777080715	OH

General Provider Information

NPI Number	:	1871124610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSETTA FAIR

Provider Business Mailing Address
First Line	:	21200 MORRIS AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123
Country	:	US
Telephone Number	:	216-209-6429
Fax Number	:

Provider Business Practice Location Address
First Line	:	21200 MORRIS AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2924
Country	:	US
Telephone Number	:	216-209-6429
Fax Number	:

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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Directions to “ ROSETTA FAIR ” Practice Location

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