Provider Demographics
NPI:1962169649
Name:ROSSI, DEZARAE THEREZE
Entity type:Individual
Prefix:
First Name:DEZARAE
Middle Name:THEREZE
Last Name:ROSSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6019
Mailing Address - Country:US
Mailing Address - Phone:401-447-6723
Mailing Address - Fax:
Practice Address - Street 1:36 JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6019
Practice Address - Country:US
Practice Address - Phone:401-447-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN62416163W00000X
RIAPRN03691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse