Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 179159 | AZ |
NPI | 1053073825 |
---|---|
Provider Name | Whitney Nicole Rosa |
First Address | Peoria, AZ 85382-9716 |
Second Address | Peoria, AZ 85382-9716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2021 |
Last Update Date | 09/10/2021 |