Individual
JENNIFER L ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1700 TUTTLE ST, BARABOO, WI 53913-3319
(608) 355-3800
(608) 355-7001
Mailing address
1700 TUTTLE ST, BARABOO, WI 53913-3319
(608) 355-3800
(608) 355-7001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
248734
AZ
363L00000X
Nurse Practitioner
11004-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902495468
—
WI
Enumeration date
01/11/2021
Last updated
03/02/2022
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