Provider Demographics
NPI:1902428360
Name:FLORES, ROSALIE BANTOG (RN)
Entity type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:BANTOG
Last Name:FLORES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11124 CORSICANA DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6414
Mailing Address - Country:US
Mailing Address - Phone:908-938-3045
Mailing Address - Fax:
Practice Address - Street 1:11124 CORSICANA DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6414
Practice Address - Country:US
Practice Address - Phone:908-938-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX773137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse