Individual
PHILLISSA KAY ROZANSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(303) 717-4168
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
RN.0124082
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN.0124082
RN LICENSE
CO
Enumeration date
09/17/2017
Last updated
06/16/2018
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