Healthcare Provider Details

I. General information

NPI: 1609376011
Provider Name (Legal Business Name): JENNIFER ROWLAND RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 03/12/2022
Certification Date: 03/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 HERITAGE CIR N
HERNANDO MS
38632-6980
US

IV. Provider business mailing address

1304 HERITAGE CIR N
HERNANDO MS
38632-6980
US

V. Phone/Fax

Practice location:
  • Phone: 870-723-7808
  • Fax:
Mailing address:
  • Phone: 870-723-7808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR68915
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR68915
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: