Provider Demographics
NPI:1093364911
Name:ROSEN, WHITNEY RONDELL (PA-C)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:RONDELL
Last Name:ROSEN
Suffix:
Gender:
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 1:9049 SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-4926
Mailing Address - Country:US
Mailing Address - Phone:937-759-0545
Mailing Address - Fax:937-759-0549
Practice Address - Street 1:9049 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4926
Practice Address - Country:US
Practice Address - Phone:937-759-0545
Practice Address - Fax:937-759-0549
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006111RX363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372406Medicaid