MEDICARE: JEANNE M ROTHAMEL RN

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	163WX0601X	Otorhinolaryngology & Head-Neck Registered Nurse	059176	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	059176	OTHER	IA	RN LICENSE

General Provider Information

NPI Number	:	1619962065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE M ROTHAMEL RN

Provider Business Mailing Address
First Line	:	312 9TH ST SW
Second Line	:	STE 3000
City	:	WAVERLY
State	:	IA
Zip	:	50677-2929
Country	:	US
Telephone Number	:	319-352-8891
Fax Number	:	319-352-8896

Provider Business Practice Location Address
First Line	:	312 9TH ST SW
Second Line	:	STE 3000
City	:	WAVERLY
State	:	IA
Zip	:	50677-2929
Country	:	US
Telephone Number	:	319-352-8891
Fax Number	:	319-352-8896

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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