Provider Demographics
NPI:1538841549
Name:ROSBECK, NICOLE LAWRENCE (CN0030085465)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAWRENCE
Last Name:ROSBECK
Suffix:
Gender:F
Credentials:CN0030085465
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OAK CIR S
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3344
Mailing Address - Country:US
Mailing Address - Phone:470-808-2610
Mailing Address - Fax:
Practice Address - Street 1:112 OAK CIR S
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3344
Practice Address - Country:US
Practice Address - Phone:470-808-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030085465376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide