Provider Demographics
NPI:1093998858
Name:JAEKEL, ROSEMARIE CATHERINE (RN, MSN, CFNP)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:CATHERINE
Last Name:JAEKEL
Suffix:
Gender:F
Credentials:RN, MSN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 I-30
Mailing Address - Street 2:BLDG. B-130
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2651
Mailing Address - Country:US
Mailing Address - Phone:972-686-6400
Mailing Address - Fax:
Practice Address - Street 1:3500 I-30
Practice Address - Street 2:BLDG. B-130
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2651
Practice Address - Country:US
Practice Address - Phone:972-686-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX430233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX430233OtherTEXAS