Provider Demographics
NPI:1942664461
Name:ROUAN, JESSICA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:ROUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-966-4653
Mailing Address - Fax:919-966-8440
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-2757
Practice Address - Country:US
Practice Address - Phone:919-966-4653
Practice Address - Fax:919-966-8440
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program