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General NPI Number Information
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NPI Number | 1033478383
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Entity Type | Organization
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Legal Business Name | ROCKFORD SCHOOL DISTRICT
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 401 N GARDINER AVE
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City | ROCKFORD
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State | IL
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Zip | 61107-4338
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Country | US
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Telephone | 815-398-3976
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Fax |
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Provider Business Mailing Address
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Address Line | 401 N GARDINER AVE
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City | ROCKFORD
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State | IL
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Zip | 61107-4338
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Country | US
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Telephone | 815-398-3976
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Fax |
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Authorized Official
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Title or Position | CERTIFIED SCHOOL NURSE
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Name | MRS. SUSAN FRASER SIMMERMAN
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Credential |
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Telephone | 815-398-3976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | 041.143917
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License Number State | IL
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