Provider Demographics
NPI:1457925349
Name:ROSARIO-PIRTLE, JACKIE A
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:A
Last Name:ROSARIO-PIRTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-1865
Mailing Address - Country:US
Mailing Address - Phone:219-670-5438
Mailing Address - Fax:
Practice Address - Street 1:205 E 86TH CT STE 205
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6259
Practice Address - Country:US
Practice Address - Phone:219-670-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist