Provider Demographics
NPI:1396825428
Name:VON ROTHE, JILL ANNE (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:ANNE
Last Name:VON ROTHE
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:12000 MARKET ST APT 202
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5697
Mailing Address - Country:US
Mailing Address - Phone:703-283-1344
Mailing Address - Fax:703-790-3444
Practice Address - Street 1:1825 SAMUEL MORSE DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5317
Practice Address - Country:US
Practice Address - Phone:703-893-6168
Practice Address - Fax:703-790-3444
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024105825367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered