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General NPI Number Information
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NPI Number | 1356572580
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Entity Type | Individual
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Provider Name | JENNIFER LYNN ROSICS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 5850 E 2ND ST UNIT 100
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City | CASPER
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State | WY
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Zip | 82609-4343
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Country | US
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Telephone | 307-212-6270
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 COMMERCIAL WAY STE 20
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4705
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Country | US
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Telephone | 307-212-6270
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | TL478
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | TL478
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License Number State | WY
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