Basic Information
| Provider Information | |||||||||
| NPI: | 1730354127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENBERG | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LERNER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 N BETHLEHEM PIKE | ||||||||
| Address2: | |||||||||
| City: | LOWER GWYNEDD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190022501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156432119 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 605 N BETHLEHEM PIKE | ||||||||
| Address2: | |||||||||
| City: | LOWER GWYNEDD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190022501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156432119 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2008 | ||||||||
| LastUpdateDate: | 03/27/2018 | ||||||||
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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 | 163W00000X | RN519481L | PA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | VP006726B | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 103002674 | 05 | PA | MEDICAID |