Basic Information
| Provider Information | |||||||||
| NPI: | 1487656955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROZUM | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 SOARING OWL AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891291832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023969147 | ||||||||
| FaxNumber: | 7023965013 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 N TENAYA WAY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022555025 | ||||||||
| FaxNumber: | 7022555015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 07/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 10814 | NV | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | 10814 | NV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 100503112 | 05 | NV | MEDICAID |