Provider Demographics
NPI:1508627597
Name:MROFCHAK, JACQUELYN NICOLE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:NICOLE
Last Name:MROFCHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JACCI
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1656 ROBERTS LN NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-3620
Mailing Address - Country:US
Mailing Address - Phone:330-610-4631
Mailing Address - Fax:
Practice Address - Street 1:1656 ROBERTS LN NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3620
Practice Address - Country:US
Practice Address - Phone:330-610-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty