Provider Demographics
NPI:1619656345
Name:ROETS, JENNIFER (OPERATOR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROETS
Suffix:
Gender:F
Credentials:OPERATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DES MOINES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67505-2143
Mailing Address - Country:US
Mailing Address - Phone:316-293-8541
Mailing Address - Fax:
Practice Address - Street 1:61 DES MOINES AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67505-2143
Practice Address - Country:US
Practice Address - Phone:316-293-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1422251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health