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General NPI Number Information
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NPI Number | 1366561870
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Entity Type | Individual
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Provider Name | JACQUELINE L ROETHLISBERGER NP
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 3700 SOUTHERN BLVD STE 201
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City | KETTERING
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State | OH
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Zip | 45429-1265
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Country | US
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Telephone | 855-500-2873
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Fax | 937-281-3992
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Provider Business Mailing Address
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Address Line | 1 PRESTIGE PL STE 550
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City | MIAMISBURG
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State | OH
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Zip | 45342-6115
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Country | US
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Telephone | 937-762-1310
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Fax | 937-522-8068
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN 199132 COA
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | COA 03334 NP
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License Number State | OH
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