Provider Demographics
NPI:1871789099
Name:REISWEBER, ROSEANN MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:MARIE
Last Name:REISWEBER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3128
Mailing Address - Country:US
Mailing Address - Phone:262-506-4431
Mailing Address - Fax:262-338-3111
Practice Address - Street 1:1106 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3128
Practice Address - Country:US
Practice Address - Phone:262-506-4431
Practice Address - Fax:262-338-3111
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35040700Medicare PIN