Healthcare Provider Details

I. General information

NPI: 1669239851
Provider Name (Legal Business Name): JAMIE LYNN ROTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE ROTMAN CNC

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LE PARC CIR
BUFFALO GROVE IL
60089-6908
US

IV. Provider business mailing address

300 LE PARC CIR
BUFFALO GROVE IL
60089-6908
US

V. Phone/Fax

Practice location:
  • Phone: 847-414-4484
  • Fax:
Mailing address:
  • Phone: 847-414-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1200465866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: