Healthcare Provider Details

I. General information

NPI: 1366441099
Provider Name (Legal Business Name): JAYNE M ROTH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3604
  • Fax: 419-479-6971
Mailing address:
  • Phone: 419-291-3604
  • Fax: 419-479-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM-08128
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number08128
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: