Provider Demographics
NPI:1023494952
Name:ROSENBECK, KATHRYN ELIZABETH (CPNP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:ROSENBECK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:SCHULZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-498-4880
Mailing Address - Fax:937-494-5295
Practice Address - Street 1:915 MICHIGAN ST STE 200
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-498-4880
Practice Address - Fax:937-494-5295
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP17496363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140653Medicaid
OHH390768Medicare PIN
OHH390764Medicare PIN
OHH390767Medicare PIN
OHH390761Medicare PIN
OHH390765Medicare PIN
OHH390763Medicare PIN
OH0140653Medicaid
OHH390766Medicare PIN
OHH390760Medicare PIN