MEDICARE: MRS. DEANNA L ROCKWELL RN

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	163WS0200X	School Registered Nurse	210871	OH

General Provider Information

NPI Number	:	1639595671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEANNA L ROCKWELL RN

Provider Business Mailing Address
First Line	:	6308 MILLERSTOWN ERIS RD.
Second Line	:
City	:	URBANA
State	:	OH
Zip	:	43078
Country	:	US
Telephone Number	:	937-663-4787
Fax Number	:	937-484-1571

Provider Business Practice Location Address
First Line	:	7941 BRUSH LAKE RD
Second Line	:
City	:	NORTH LEWISBURG
State	:	OH
Zip	:	43060-9617
Country	:	US
Telephone Number	:	937-826-3771
Fax Number	:

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

Provider Enumeration Date	:	03/14/2014
Last Update Date	:	03/14/2014

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