1881738615 NPI number — MISS ROXANNE ROESE NURSEPRACTITIONER NP

Table of content: MISS ROXANNE ROESE NURSEPRACTITIONER NP (NPI 1881738615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881738615 NPI number — MISS ROXANNE ROESE NURSEPRACTITIONER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROESE
Provider First Name:
ROXANNE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NURSEPRACTITIONER NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881738615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7139 S LOOMIS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-895-4824
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21425B SPRING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION GROVE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-878-6532
Provider Business Practice Location Address Fax Number:
262-878-6570
Provider Enumeration Date:
02/16/2007

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: 363L00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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