Provider Demographics
NPI:1275851511
Name:ROGSTAD, JESSAMY EMMA (RN)
Entity Type:Individual
Prefix:
First Name:JESSAMY
Middle Name:EMMA
Last Name:ROGSTAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 FAIRVIEW TER
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1554
Mailing Address - Country:US
Mailing Address - Phone:928-863-1878
Mailing Address - Fax:
Practice Address - Street 1:752 FAIRVIEW TER
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1554
Practice Address - Country:US
Practice Address - Phone:928-863-1878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170610-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse