Provider Demographics
NPI:1639509565
Name:ROPER, JEAN (BSRN)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:ROPER
Suffix:
Gender:F
Credentials:BSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-2121
Mailing Address - Country:US
Mailing Address - Phone:617-894-3125
Mailing Address - Fax:
Practice Address - Street 1:19 PARK DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-2121
Practice Address - Country:US
Practice Address - Phone:617-894-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN181064163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse