MEDICARE: JAMIE ROONEY APNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	14798-33	WI

General Provider Information

NPI Number	:	1770328163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE ROONEY APNP

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	WILTON
State	:	WI
Zip	:	54670-0130
Country	:	US
Telephone Number	:	262-903-2296
Fax Number	:

Provider Business Practice Location Address
First Line	:	23785 MILLSTONE AVE
Second Line	:
City	:	WILTON
State	:	WI
Zip	:	54670-8542
Country	:	US
Telephone Number	:	262-903-2296
Fax Number	:

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

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/27/2024

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