Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301103425 | MI |
N | 2080P0204X | Pediatric Emergency Doctor | 4301103425 | MI |
NPI | 1083046403 |
---|---|
Provider Name | Dr. Jennifer Magdalena Rosario |
First Address | Troy, MI 48084-4003 |
Second Address | Springfield, IL 62769-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2013 |
Last Update Date | 20/12/2021 |