Provider Demographics
NPI:1699531681
Name:ROSA, MAKENZIE (AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MAKENZIE
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MISS
Other - First Name:MAKENZIE
Other - Middle Name:
Other - Last Name:ALLREAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7495 STATE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-6400
Mailing Address - Country:US
Mailing Address - Phone:513-732-8377
Mailing Address - Fax:513-732-2618
Practice Address - Street 1:7495 STATE RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6400
Practice Address - Country:US
Practice Address - Phone:513-732-8377
Practice Address - Fax:513-732-2618
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2023063242363LA2100X
OHAPRN.CNP.0034315363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care