Provider Demographics
NPI:1356052674
Name:RUBELLO, ROSEMARIE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:LYNN
Last Name:RUBELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47378 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4783
Mailing Address - Country:US
Mailing Address - Phone:586-495-0707
Mailing Address - Fax:
Practice Address - Street 1:MEDICA CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-3328
Practice Address - Country:US
Practice Address - Phone:336-713-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-15636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant