Provider Demographics
NPI:1972349777
Name:MUNSON-BLATT, ROSA JEAN (WHNP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:JEAN
Last Name:MUNSON-BLATT
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 LEONARD ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2905
Mailing Address - Country:US
Mailing Address - Phone:617-599-4697
Mailing Address - Fax:
Practice Address - Street 1:10933 71ST RD STE 2G
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4814
Practice Address - Country:US
Practice Address - Phone:718-263-1963
Practice Address - Fax:718-268-6616
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY936764163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse