Provider Demographics
NPI:1063890077
Name:PRINCE, ROSEMARY BLACK (RN)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:BLACK
Last Name:PRINCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 GREENSVILLE COUNTY CIR
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-6349
Mailing Address - Country:US
Mailing Address - Phone:434-348-8900
Mailing Address - Fax:434-336-1027
Practice Address - Street 1:1101 GREENSVILLE COUNTY CIR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-6349
Practice Address - Country:US
Practice Address - Phone:434-348-8900
Practice Address - Fax:434-336-1027
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001086551163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse