Provider Demographics
NPI:1619962065
Name:ROTHAMEL, JEANNE M (RN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:ROTHAMEL
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 1:312 9TH ST SW
Mailing Address - Street 2:STE 3000
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2929
Mailing Address - Country:US
Mailing Address - Phone:319-352-8891
Mailing Address - Fax:319-352-8896
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:STE 3000
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-352-8891
Practice Address - Fax:319-352-8896
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA059176163WX0601X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0601XNursing Service ProvidersRegistered NurseOtorhinolaryngology & Head-Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA059176OtherRN LICENSE