Basic Information
Provider Information | |||||||||
NPI: | 1437669603 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JESSIP | ||||||||
FirstName: | SHARON | ||||||||
MiddleName: | KAY | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MALDONADO | ||||||||
OtherFirstName: | SHARON | ||||||||
OtherMiddleName: | KAY | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | SHARON KAY ROTHELL | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2200 SW GAGE BLVD | ||||||||
Address2: |   | ||||||||
City: | TOPEKA | ||||||||
State: | KS | ||||||||
PostalCode: | 666220001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7853503111 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2200 SW GAGE BLVD | ||||||||
Address2: |   | ||||||||
City: | TOPEKA | ||||||||
State: | KS | ||||||||
PostalCode: | 666220001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7853503111 | ||||||||
FaxNumber: | 7852007537 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/02/2017 | ||||||||
LastUpdateDate: | 10/02/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246QM0706X |   |   | Y |   | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Pathology | Medical Technologist |
No ID Information.