Rose of Sharon MC LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ROSE OF SHARON MC LLC

Practice address

1085 Flamingo Dr
Roselle, IL 60172-4731

Phone

(847) 877-8549

NPI assigned

Apr 9, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Reena Blesson, NP

Title

Owner

Phone

(847) 877-8549

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1164041372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 FLAMINGO DR",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601724731",
            "telephone_number": "847-877-8549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1085 FLAMINGO DR",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601724731",
            "telephone_number": "847-877-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE OF SHARON MC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-09",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "BLESSON",
        "authorized_official_first_name": "REENA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-877-8549",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.