Provider Demographics
NPI:1609023985
Name:KIROUSIS, ROSEMARY A (ANP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:A
Last Name:KIROUSIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:A
Other - Last Name:THOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-595-2700
Mailing Address - Fax:774-221-5136
Practice Address - Street 1:366 SHREWSBURY ST APT 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4647
Practice Address - Country:US
Practice Address - Phone:508-595-2700
Practice Address - Fax:774-221-5136
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner