Provider Demographics
NPI:1033478383
Name:ROCKFORD SCHOOL DISTRICT
Entity Type:Organization
Organization Name:ROCKFORD SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:FRASER
Authorized Official - Last Name:SIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-398-3976
Mailing Address - Street 1:401 N GARDINER AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4338
Mailing Address - Country:US
Mailing Address - Phone:815-398-3976
Mailing Address - Fax:
Practice Address - Street 1:401 N GARDINER AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4338
Practice Address - Country:US
Practice Address - Phone:815-398-3976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.143917261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health