Provider Demographics
NPI:1992320352
Name:ROSSETTO, EMILY LAUREN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:ROSSETTO
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 1:25148 W MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3302
Mailing Address - Country:US
Mailing Address - Phone:815-666-7810
Mailing Address - Fax:
Practice Address - Street 1:600 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3011
Practice Address - Country:US
Practice Address - Phone:217-581-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program