Roth, Jennifer L

Roth, Jennifer L is an individual health care provider with primary practice located at 1700 Tuttle St , Baraboo WI 53913-3319. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Roth, Jennifer L can be contacted via phone (608) 355-3800.

Contact Information

Primary practice address
1700 Tuttle St Baraboo WI 53913-3319
Phone: (608) 355-3800
Fax: (608) 355-7001
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 11004-33 Wisconsin
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 248734 Arizona

Profile Details

NPI number 1902495468
LBN Legal business name Roth, Jennifer L
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2021
Last updated Mar 2nd, 2022 - about 2 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 1902495468 NPPES
Wisconsin MEDICAID 1902495468

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