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Individual

JETHRONE ROLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSN, RN

Contact information

Practice address
101 E REDLANDS BLVD RM 1400B, SAN BERNARDINO, CA 92408-3710
(909) 651-4000
Mailing address
25841 SILVA CT, LOMA LINDA, CA 92354-6551
(323) 346-5980

Taxonomy

Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
676330
CA

Other

Enumeration date
09/10/2017
Last updated
09/10/2017
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