MEDICARE: JONATHAN ROHWER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	8496855-4405	UT

General Provider Information

NPI Number	:	1174909139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ROHWER APRN

Provider Business Mailing Address
First Line	:	543 E CENTER ST
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-2107
Country	:	US
Telephone Number	:	801-928-6613
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 W 2100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-1223
Country	:	US
Telephone Number	:	801-974-3382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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