Provider Demographics
NPI:1700173390
Name:JERVIS-ROZYCKI, VICKY ANN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:ANN
Last Name:JERVIS-ROZYCKI
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 TAYLOR ST
Mailing Address - Street 2:SUITE 4-E
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2923
Mailing Address - Country:US
Mailing Address - Phone:803-296-8906
Mailing Address - Fax:803-296-8908
Practice Address - Street 1:1333 TAYLOR ST
Practice Address - Street 2:SUITE 4-E
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2923
Practice Address - Country:US
Practice Address - Phone:803-296-8906
Practice Address - Fax:803-296-8908
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97811163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy