1356811384 NPI number — JACQUELINE ANNE RODWICK FNP-BC

Table of content: JACQUELINE ANNE RODWICK FNP-BC (NPI 1356811384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356811384 NPI number — JACQUELINE ANNE RODWICK FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODWICK
Provider First Name:
JACQUELINE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESSIER
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356811384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9960 STONE CT NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87114-4109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-328-8117
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8400 OSUNA RD NE STE 5C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87111-2072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-585-2345
Provider Business Practice Location Address Fax Number:
505-800-5030
Provider Enumeration Date:
12/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  54197 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com