Provider Demographics
NPI:1528068780
Name:MALENFANT, ROSANN R (CRNA)
Entity type:Individual
Prefix:
First Name:ROSANN
Middle Name:R
Last Name:MALENFANT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 711052
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45273-0001
Mailing Address - Country:US
Mailing Address - Phone:614-898-6659
Mailing Address - Fax:614-898-8631
Practice Address - Street 1:500 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8971
Practice Address - Country:US
Practice Address - Phone:614-898-6659
Practice Address - Fax:614-898-8631
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019189174400000X
FLARNP9174500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHR40283Medicare UPIN