Roethlisberger, Jacqueline L

Roethlisberger, Jacqueline L is an individual health care provider with primary practice located at 3700 Southern Blvd Ste 201 , Kettering OH 45429-1265. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Roethlisberger, Jacqueline L can be contacted via phone (855) 500-2873.

Contact Information

Primary practice address
3700 Southern Blvd Ste 201 Kettering OH 45429-1265
Phone: (855) 500-2873
Fax: (937) 281-3992
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X RN 199132 COA Ohio
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X COA 03334 NP Ohio

Profile Details

NPI number 1366561870
LBN Legal business name Roethlisberger, Jacqueline L
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 28th, 2007
Last updated Apr 12th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366561870 NPPES
Ohio MEDICAID 2731806

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