MEDICARE: MRS. JULIA JASKWHICH RODRIGUEZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN109735	SC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4422	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295974616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA JASKWHICH RODRIGUEZ APRN

Provider Business Mailing Address
First Line	:	1620 ASHLEY RIVER RD
Second Line	:	BUILDING J
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5902
Country	:	US
Telephone Number	:	843-556-8177
Fax Number	:	843-571-2742

Provider Business Practice Location Address
First Line	:	1616 ASHLEY RIVER RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5902
Country	:	US
Telephone Number	:	843-556-9177
Fax Number	:	843-571-2742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	09/25/2019

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