Provider Demographics
NPI:1982855904
Name:ROSENTRETER, JENNIFER JAMES (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JAMES
Last Name:ROSENTRETER
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 1:1102 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2930
Mailing Address - Country:US
Mailing Address - Phone:307-640-1446
Mailing Address - Fax:
Practice Address - Street 1:1102 W 27TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2930
Practice Address - Country:US
Practice Address - Phone:307-640-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY18151163W00000X
171M00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator