Basic Information
| Provider Information | |||||||||
| NPI: | 1336387695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSSETTI | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20265 EMERY RD | ||||||||
| Address2: | #255 | ||||||||
| City: | NORTH RANDALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441284122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405239966 | ||||||||
| FaxNumber: | 2165842895 | ||||||||
| Practice Location | |||||||||
| Address1: | 25000 COUNTRY CLUB BLVD | ||||||||
| Address2: | #255 | ||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440705344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408930200 | ||||||||
| FaxNumber: | 4407937194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2009 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | A0908110 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | A0908110 | 01 | OH | OHIO LICENSE | OTHER |