Provider Demographics
NPI:1669011904
Name:JEAN, ROGELINE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ROGELINE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WESICKAMAN DR
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8957
Mailing Address - Country:US
Mailing Address - Phone:912-856-8971
Mailing Address - Fax:
Practice Address - Street 1:7515 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-3710
Practice Address - Country:US
Practice Address - Phone:267-335-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty