Provider Demographics
NPI:1477304772
Name:ROTH, JENETTE M
Entity Type:Individual
Prefix:MS
First Name:JENETTE
Middle Name:M
Last Name:ROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 RHODES ST
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650-9403
Mailing Address - Country:US
Mailing Address - Phone:928-530-0813
Mailing Address - Fax:
Practice Address - Street 1:701 RHODES ST
Practice Address - Street 2:
Practice Address - City:PINCONNING
Practice Address - State:MI
Practice Address - Zip Code:48650-9403
Practice Address - Country:US
Practice Address - Phone:928-530-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide