Healthcare Provider Details

I. General information

NPI: 1962851063
Provider Name (Legal Business Name): JESSICA ROSSMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

205 N EAST AVE
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-4963
  • Fax: 517-205-7352
Mailing address:
  • Phone: 517-205-4963
  • Fax: 517-205-7352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704283007
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: