Provider Demographics
NPI:1003087842
Name:ROACH, ANNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-2520
Mailing Address - Country:US
Mailing Address - Phone:314-385-1965
Mailing Address - Fax:314-381-3199
Practice Address - Street 1:5449 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120-2520
Practice Address - Country:US
Practice Address - Phone:314-385-1965
Practice Address - Fax:314-381-3199
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0705033747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant