Provider Demographics
NPI:1578635405
Name:ROHRER, JEAN M (CRNP MSN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:ROHRER
Suffix:
Gender:F
Credentials:CRNP MSN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:22820 E APPLEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9514
Mailing Address - Country:US
Mailing Address - Phone:406-407-1499
Mailing Address - Fax:
Practice Address - Street 1:22820 E APPLEWAY AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-9514
Practice Address - Country:US
Practice Address - Phone:406-407-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60663107363L00000X, 363LF0000X
IDNP-748A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S72891Medicare UPIN