MEDICARE: JEAN M ROHRER CRNP MSN

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	363L00000X	Nurse Practitioner	AP60663107	WA
2	363LF0000X	Family Nurse Practitioner	NP-748A	ID
3	363LF0000X	Family Nurse Practitioner	AP60663107	WA

General Provider Information

NPI Number	:	1578635405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN M ROHRER CRNP MSN

Provider Business Mailing Address
First Line	:	22820 E APPLEWAY AVE
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-9514
Country	:	US
Telephone Number	:	406-407-1499
Fax Number	:

Provider Business Practice Location Address
First Line	:	22820 E APPLEWAY AVE
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-9514
Country	:	US
Telephone Number	:	406-407-1499
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	03/09/2020

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