Provider Demographics
NPI:1770314338
Name:ROSSETTI, SUSAN (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROSSETTI
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:ROSSETTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP, PMHNP
Mailing Address - Street 1:4729 OPUS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8694
Mailing Address - Country:US
Mailing Address - Phone:719-289-3173
Mailing Address - Fax:
Practice Address - Street 1:4729 OPUS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8694
Practice Address - Country:US
Practice Address - Phone:719-289-3173
Practice Address - Fax:866-718-1677
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAARNP.AP.61599292-NP363LP0808X
COC-APN.0102873363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health