Provider Demographics
NPI:1174594097
Name:ROWLES, JACQUELINE S (CRNA, ANP-BC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:ROWLES
Suffix:
Gender:F
Credentials:CRNA, ANP-BC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:ROWLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA, ANP-BC
Mailing Address - Street 1:15272 KAMPEN CIR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-0002
Mailing Address - Country:US
Mailing Address - Phone:574-268-9640
Mailing Address - Fax:
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:574-268-9640
Practice Address - Fax:574-268-0684
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28084276A367500000X
IN71004611A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200000030Medicaid
ININ2024Medicare PIN
IN200000030Medicaid