Provider Demographics
NPI:1871723940
Name:JINDAL, ROSILYN (PA)
Entity type:Individual
Prefix:
First Name:ROSILYN
Middle Name:
Last Name:JINDAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26308 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6208
Mailing Address - Country:US
Mailing Address - Phone:419-290-8811
Mailing Address - Fax:
Practice Address - Street 1:2727 E BEECHER ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3506
Practice Address - Country:US
Practice Address - Phone:517-265-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant