Healthcare Provider Details

I. General information

NPI: 1598042731
Provider Name (Legal Business Name): JESSICA E ROSETTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 REMIT DR # 1056
CHICAGO IL
60675-1056
US

IV. Provider business mailing address

1025 CENTER ST
ASHLAND OH
44805-4011
US

V. Phone/Fax

Practice location:
  • Phone: 866-916-5259
  • Fax: 231-922-4030
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003436
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: