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General NPI Number Information
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NPI Number | 1043305469
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Entity Type | Individual
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Provider Name | JEANNETTE EDITH RODRIGUEZ FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 2525 W ANDERSON LN # 152
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City | AUSTIN
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State | TX
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Zip | 78757-1180
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Country | US
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Telephone | 512-988-5355
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Fax |
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Provider Business Mailing Address
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Address Line | 125 S CLARK ST STE 900
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City | CHICAGO
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State | IL
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Zip | 60603-4043
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Country | US
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Telephone | 512-988-5355
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP128687
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License Number State | TX
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