Healthcare Provider Details

I. General information

NPI: 1174594097
Provider Name (Legal Business Name): JACQUELINE S ROWLES CRNA, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE ROWLES CRNA, ANP-BC

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 N MERIDIAN ST LOWER LEVEL
INDIANAPOLIS IN
46260-5381
US

IV. Provider business mailing address

15272 KAMPEN CIR
CARMEL IN
46033-0002
US

V. Phone/Fax

Practice location:
  • Phone: 574-268-9640
  • Fax: 574-268-0684
Mailing address:
  • Phone: 574-268-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28084276A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71004611A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: