Provider Demographics
NPI:1841351434
Name:THEMISTOCLES, ROSANA (CRNA)
Entity type:Individual
Prefix:
First Name:ROSANA
Middle Name:
Last Name:THEMISTOCLES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S GREENE ST
Mailing Address - Street 2:PATIENT CARE SERVICES G1K01
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-8667
Mailing Address - Fax:
Practice Address - Street 1:920 STANTON L YOUNG BLVD STE 1140
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5036
Practice Address - Country:US
Practice Address - Phone:405-271-4351
Practice Address - Fax:405-271-8665
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN548809367500000X
MDR221379367500000X
FLARNP9415041367500000X
OK207199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3810011721Medicaid
CARN548809Medicaid
CARN548809Medicaid
CAQ40845Medicare UPIN
VA3810011721Medicaid