Provider Demographics
NPI:1295258572
Name:ROSSETTO, MARINE ALEXANDRA
Entity type:Individual
Prefix:
First Name:MARINE
Middle Name:ALEXANDRA
Last Name:ROSSETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 ISHERWOOD ST NE APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5521
Mailing Address - Country:US
Mailing Address - Phone:888-709-0961
Mailing Address - Fax:
Practice Address - Street 1:1516 ISHERWOOD ST NE APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:888-709-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
217-2-1019374J00000X
MI20110506374J00000X
374J00000X
MO21721019374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty