Provider Demographics
NPI:1972231645
Name:ROSENDALE, REYGHAN
Entity type:Individual
Prefix:
First Name:REYGHAN
Middle Name:
Last Name:ROSENDALE
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 1:3000 ARLINGTON AVE # MS 1108
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-383-6105
Mailing Address - Fax:419-383-3153
Practice Address - Street 1:1125 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8001
Practice Address - Country:US
Practice Address - Phone:419-383-6105
Practice Address - Fax:419-383-3153
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily