MEDICARE: MRS. JACQUELYN EDITH ROCKMAN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	1034848	AL

General Provider Information

NPI Number	:	1568490936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELYN EDITH ROCKMAN CRNA

Provider Business Mailing Address
First Line	:	4028 MEREDITH DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2343
Country	:	US
Telephone Number	:	334-549-2903
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CHERRY ST
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-5626
Country	:	US
Telephone Number	:	334-549-2903
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/06/2015

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