Provider Demographics
NPI:1992269278
Name:ROSENBERGER, SUSAN LEIGH (OMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEIGH
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9675 BENEDICT DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89161-2505
Mailing Address - Country:US
Mailing Address - Phone:646-753-0742
Mailing Address - Fax:
Practice Address - Street 1:9345 S CIMARRON RD STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-2505
Practice Address - Country:US
Practice Address - Phone:646-753-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty