Healthcare Provider Details

I. General information

NPI: 1255287736
Provider Name (Legal Business Name): JEANETTE MARIE MARRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE MARIE MARRERO-RUSSON

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E COTATI AVE
ROHNERT PARK CA
94928-3613
US

IV. Provider business mailing address

1801 E COTATI AVE
ROHNERT PARK CA
94928-3613
US

V. Phone/Fax

Practice location:
  • Phone: 707-664-2465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95288959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: