Provider Demographics
NPI:1528209285
Name:ROSKOS, CARRIE D (CNA)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:D
Last Name:ROSKOS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W20298 STATE ROAD 121
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-9685
Mailing Address - Country:US
Mailing Address - Phone:715-538-4518
Mailing Address - Fax:
Practice Address - Street 1:W20298 STATE ROAD 121
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-9685
Practice Address - Country:US
Practice Address - Phone:715-538-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126827376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI126827OtherWISCONSIN NURSE AIDE REGISTRY