Provider Demographics
NPI:1588080782
Name:TAKACS, ROSEMARY (RN, BS, CDE)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:TAKACS
Suffix:
Gender:F
Credentials:RN, BS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:SUITE L 4
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1241
Mailing Address - Country:US
Mailing Address - Phone:570-604-6677
Mailing Address - Fax:570-307-4220
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:SUITE L 4
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1241
Practice Address - Country:US
Practice Address - Phone:570-604-6677
Practice Address - Fax:570-307-4220
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-199951-L163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator