Provider Demographics
NPI:1346734266
Name:ROTUNNO, JOHN (LVN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ROTUNNO
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 WESTPARK DR APT 2306
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-5134
Mailing Address - Country:US
Mailing Address - Phone:713-257-5192
Mailing Address - Fax:
Practice Address - Street 1:10215 BERRYBRIAR LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-0433
Practice Address - Country:US
Practice Address - Phone:713-257-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319344164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse