Basic Information
| Provider Information | |||||||||
| NPI: | 1700173390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JERVIS-ROZYCKI | ||||||||
| FirstName: | VICKY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 TAYLOR ST | ||||||||
| Address2: | SUITE 4-E | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032968906 | ||||||||
| FaxNumber: | 8032968908 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 TAYLOR ST | ||||||||
| Address2: | SUITE 4-E | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032968906 | ||||||||
| FaxNumber: | 8032968908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2011 | ||||||||
| LastUpdateDate: | 07/01/2011 | ||||||||
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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 | 163WE0900X | 97811 | SC | Y | Nursing Service Providers | Registered Nurse | Enterostomal Therapy |
No ID Information.