Provider Demographics
NPI:1285290536
Name:ROSSER, ANNISSA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANNISSA
Middle Name:
Last Name:ROSSER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ANNISSA
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:6549 TOWN CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:800-395-3223
Mailing Address - Fax:
Practice Address - Street 1:8150 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-8700
Practice Address - Country:US
Practice Address - Phone:800-395-3223
Practice Address - Fax:833-329-6632
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704316591163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse