Individual
JACQUELINE L ROETHLISBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3700 SOUTHERN BLVD STE 201, KETTERING, OH 45429-1265
(855) 500-2873
(937) 281-3992
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 762-1310
(937) 522-8068
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
COA 03334 NP
OH
363LA2200X
Adult Health Nurse Practitioner
RN 199132 COA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2731806
—
OH
Enumeration date
03/28/2007
Last updated
04/12/2022
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