Basic Information
| Provider Information | |||||||||
| NPI: | 1568801009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REBUSTILLO | ||||||||
| FirstName: | ROSE-THERESE | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 SOUTH ST | ||||||||
| Address2: | UNIT B | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191471956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013945502 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 CHESTNUT ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191062614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673227700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN624686 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.