1093148223 NPI number — MRS. JULIE L ROESKE

Table of content: MRS. JULIE L ROESKE (NPI 1093148223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093148223 NPI number — MRS. JULIE L ROESKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROESKE
Provider First Name:
JULIE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRANCIS
Provider Other First Name:
JULIE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093148223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT HELENS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97051-8234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-397-5211
Provider Business Mailing Address Fax Number:
503-397-5373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 1234
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT HELENS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97051-8234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-397-5211
Provider Business Practice Location Address Fax Number:
503-397-5373
Provider Enumeration Date:
08/12/2013

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: 172V00000X , with the licence number:  108927 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1093148223 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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