Provider Demographics
NPI:1427071927
Name:WASHINGTON, ROSANNE (PA)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 RANGE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2026
Mailing Address - Country:US
Mailing Address - Phone:603-894-0063
Mailing Address - Fax:603-894-9727
Practice Address - Street 1:58 RANGE RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2026
Practice Address - Country:US
Practice Address - Phone:603-894-0063
Practice Address - Fax:603-894-9727
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001317363A00000X
NH684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002235Medicare PIN
CTQ01655Medicare UPIN