Provider Demographics
NPI:1902917404
Name:ROSENHAGEN, KATHLEEN (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ROSENHAGEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ROSENHAGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:305 UPTOWN SQ
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0574
Mailing Address - Country:US
Mailing Address - Phone:615-904-1650
Mailing Address - Fax:615-904-0598
Practice Address - Street 1:305 UPTOWN SQ
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0574
Practice Address - Country:US
Practice Address - Phone:615-904-1650
Practice Address - Fax:615-904-0598
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner