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General NPI Number Information
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NPI Number | 1477391233
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Entity Type | Individual
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Provider Name | JONATHAN TIMOTHY ROONEY
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Gender | Male
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Dates
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Enumeration Date | 07/17/2024
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 3200 E RACINE ST
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City | JANESVILLE
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State | WI
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Zip | 53546-2343
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Country | US
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Telephone | 608-371-8000
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Fax | 608-371-8939
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Provider Business Mailing Address
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Address Line | 462 S 5TH ST
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City | EVANSVILLE
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State | WI
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Zip | 53536-1218
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Country | US
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Telephone | 608-490-0480
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 15491-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 15491-33
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License Number State | WI
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