Provider Demographics
NPI:1295095016
Name:GARRETT, ROSALEEN MARIE (BSN, MSN)
Entity type:Individual
Prefix:
First Name:ROSALEEN
Middle Name:MARIE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:BSN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27820 RACKHAM DR
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3306
Mailing Address - Country:US
Mailing Address - Phone:248-552-8482
Mailing Address - Fax:
Practice Address - Street 1:2333 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:734-324-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-26
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246902363LA2100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse