Provider Demographics
NPI:1932874591
Name:ROSEMANN, JESSICA LAKE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAKE
Last Name:ROSEMANN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3206
Mailing Address - Country:US
Mailing Address - Phone:801-884-3280
Mailing Address - Fax:
Practice Address - Street 1:911 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-3206
Practice Address - Country:US
Practice Address - Phone:801-884-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5905489-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily