Healthcare Provider Details

I. General information

NPI: 1063738144
Provider Name (Legal Business Name): JESSICA JANE ROTHROCK RN, BSN, COCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 TOWNSHIP ROAD 2506
PERRYSVILLE OH
44864-9713
US

IV. Provider business mailing address

911 TOWNSHIP ROAD 2506
PERRYSVILLE OH
44864-9713
US

V. Phone/Fax

Practice location:
  • Phone: 256-613-4867
  • Fax:
Mailing address:
  • Phone: 256-613-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number337947
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: