Provider Demographics
NPI:1396200523
Name:DE ROZIERE, ROBERT ANDRE JR (FNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDRE
Last Name:DE ROZIERE
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 TABOR AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1425
Mailing Address - Country:US
Mailing Address - Phone:937-818-6216
Mailing Address - Fax:
Practice Address - Street 1:MARIA JOSEPH CARE CENTER
Practice Address - Street 2:4780 SALEM AVENUE
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416
Practice Address - Country:US
Practice Address - Phone:937-278-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024148363LF0000X
OHAPRN.CNP024148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily