Provider Demographics
NPI:1902269939
Name:ROSADO, DEIDANIA E (CRNP)
Entity Type:Individual
Prefix:
First Name:DEIDANIA
Middle Name:E
Last Name:ROSADO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEIDANIA
Other - Middle Name:E
Other - Last Name:ZERANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:300 BRETZ CT STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8615
Mailing Address - Country:US
Mailing Address - Phone:717-567-3174
Mailing Address - Fax:717-703-0018
Practice Address - Street 1:300 BRETZ CT
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-8614
Practice Address - Country:US
Practice Address - Phone:717-567-3174
Practice Address - Fax:717-703-0018
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103101369Medicaid
PA103101369Medicaid