Provider Demographics
NPI:1104168418
Name:ROSENBAUER, MARY J (MS, RNC, CPNP, IBCLC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:ROSENBAUER
Suffix:
Gender:F
Credentials:MS, RNC, CPNP, IBCLC
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:JO
Other - Last Name:ROSENBAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RNC, CPNP, IBCLC
Mailing Address - Street 1:1 CHILDRENS PLZ
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1873
Mailing Address - Country:US
Mailing Address - Phone:937-641-3000
Mailing Address - Fax:937-641-5436
Practice Address - Street 1:1 CHILDRENS PLZ
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1873
Practice Address - Country:US
Practice Address - Phone:937-641-3000
Practice Address - Fax:937-641-5436
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN205022163WL0100X, 163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care