Provider Demographics
NPI:1063738144
Name:ROTHROCK, JESSICA JANE (RN, BSN, COCN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:ROTHROCK
Suffix:
Gender:F
Credentials:RN, BSN, COCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 TOWNSHIP ROAD 2506
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864-9713
Mailing Address - Country:US
Mailing Address - Phone:256-613-4867
Mailing Address - Fax:
Practice Address - Street 1:911 TOWNSHIP ROAD 2506
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9713
Practice Address - Country:US
Practice Address - Phone:256-613-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH337947163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health