Provider Demographics
NPI:1669239851
Name:ROTMAN, JAMIE LYNN
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:ROTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:ROTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNC
Mailing Address - Street 1:300 LE PARC CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6908
Mailing Address - Country:US
Mailing Address - Phone:847-414-4484
Mailing Address - Fax:
Practice Address - Street 1:300 LE PARC CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6908
Practice Address - Country:US
Practice Address - Phone:847-414-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1200465866133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist