Healthcare Provider Details

I. General information

NPI: 1861840019
Provider Name (Legal Business Name): JAMIE KAZLAUSKAS ROSEBROCK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FOGG RD
WEYMOUTH MA
02190-2432
US

IV. Provider business mailing address

22 BRANDON RD # 2
MILTON MA
02186-1616
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-8000
  • Fax:
Mailing address:
  • Phone: 803-743-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN10021553
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: